Zone J J, Meyer L J, Petersen M J
Medicine Service, Veterans Affairs Medical Center, Salt Lake City, Utah, USA.
Arch Dermatol. 1996 Aug;132(8):912-8.
To compare the deposition of IgA and C3 in the skin of patients with active dermatitis herpetiformis relative to the sites of disease.
In the phase 1 study, skin biopsy specimens were obtained from erythematous perilesional skin, nonerythematous perilesional skin, and never-involved skin. In the phase 2 study, specimens from the nonerythematous perilesional and uninvolved skin from the same anatomic region were sampled.
The Dermatology Clinic at the University of Utah Health Sciences Center, Salt Lake City.
Patients with known dermatitis herpetiformis: 19 patients in the phase 1 study and 15 patients in the phase 2 study. Suppressive medications were stopped for 48 to 72 hours after biopsy specimens were obtained. All patients had active disease at the time that biopsy specimens were taken.
The intensity of IgA and C3 immunofluorescent staining in 6 sections from each skin biopsy specimen was graded by using a semiquantitative scale (0 to 3+) in a blinded fashion by a single observer.
Deposition of IgA was more intense in noninflamed perilesional skin in 11 of 19 patients compared with that in erythematous skin (P < .05). Erythematous skin was negative for IgA in 16% (3/19) of the specimens. Noninflamed perilesional skin showed more intense IgA deposition in 18 of 19 specimens compared with that in never-involved skin (P < .01); C3 was more intense in erythematous skin (P < .01). In the phase 2 study, skin from the same anatomic region revealed greater deposition of IgA near lesions in 12 of 15 patients (P < .001).
In patients with dermatitis herpetiformis, IgA is not uniformly distributed throughout the skin, and IgA is present in greater amounts near active lesions. The preferred biopsy site for the diagnosis of dermatitis herpetiformis is normal-appearing skin that is adjacent to an active lesion.
比较活动性疱疹样皮炎患者皮肤中IgA和C3的沉积情况与疾病部位的关系。
在1期研究中，从红斑性皮损周围皮肤、非红斑性皮损周围皮肤和从未受累皮肤获取皮肤活检标本。在2期研究中，从同一解剖区域的非红斑性皮损周围皮肤和未受累皮肤取样。
盐湖城犹他大学健康科学中心皮肤科诊所。
已知疱疹样皮炎患者：1期研究中有19例患者，2期研究中有15例患者。活检标本获取后，停用抑制性药物48至72小时。所有患者在取活检标本时均患有活动性疾病。
由一名观察者以盲法使用半定量量表（0至3+）对每个皮肤活检标本的6个切片中IgA和C3免疫荧光染色强度进行分级。
19例患者中有11例，非炎症性皮损周围皮肤中IgA的沉积比红斑性皮肤更强烈（P<.05）。16%（3/19）的标本中，红斑性皮肤的IgA呈阴性。19个标本中有18个显示，非炎症性皮损周围皮肤的IgA沉积比从未受累皮肤更强烈（P<.01）；C3在红斑性皮肤中更强烈（P<.01）。在2期研究中，同一解剖区域的皮肤显示，15例患者中有12例病变附近的IgA沉积更多（P<.001）。
在疱疹样皮炎患者中，IgA在皮肤中分布不均，且在活动性病变附近含量更高。诊断疱疹样皮炎的首选活检部位是与活动性病变相邻的外观正常的皮肤。
