Haas N, Toppe E, Henz B M
Department of Dermatology, Virchow Klinikum, Humboldt University, Berlin, Germany.
Arch Dermatol. 1998 Jan;134(1):41-6. doi: 10.1001/archderm.134.1.41.
To identify possible special histopathologic features of different types of urticaria.
Hematoxylin-eosin- and toluidine blue-stained sections from biopsy specimens of all patients with urticaria seen from 1990 to 1993.
Inpatient and outpatient services of the Virchow Klinikum, Humboldt University, Berlin, Germany.
We studied spontaneous or induced wheals of 108 patients with acute, chronic, and physical urticaria who consented to an additional biopsy from uninvolved skin. The controls were 10 normal volunteers with wheals that tested positive on a prick test and who had contralateral normal skin.
Mast cell numbers in both lesional and nonlesional skin in the upper and lower dermis of biopsy specimens from patients and controls.
Blind evaluations of microscopic sections showed dermal edema and dilated lymphatic and vascular (P < .001 for all, Fisher exact test) capillaries almost exclusively in involved skin. The same held for inflammatory infiltrates, with significantly increased numbers of neutrophils and eosinophils in specimens from patients with acute urticaria and those with delayed pressure urticaria (P < .01 for each). Mast cell numbers were higher in the upper (P < .01) and lower dermis (P < .05) of lesional and uninvolved skin of all patients with urticaria, with a further increase (P < .01) in patients with disease of more than 10 weeks' duration. Edema and vascular changes were most prominent in the skin of patients with cold urticaria (P < .005) and mononuclear infiltrates were more pronounced in those with cold urticaria, chronic urticaria, and prick test-positive wheals (P < .05 for each) and in the lower dermis of patients with delayed pressure urticaria (P < .001).
In all types of urticaria, mechanisms must be operative that cause an increase of cutaneous mast cells. Distinctive pathological features can be identified in different types of urticaria, although these are not diagnostic.
确定不同类型荨麻疹可能的特殊组织病理学特征。
对1990年至1993年间诊治的所有荨麻疹患者活检标本进行苏木精-伊红染色和甲苯胺蓝染色切片观察。
德国柏林洪堡大学维尔肖临床医院的住院部和门诊部。
我们研究了108例急性、慢性和物理性荨麻疹患者的自发性或诱发性风团，这些患者同意对未受累皮肤进行额外活检。对照组为10名正常志愿者，其风团在点刺试验中呈阳性，且对侧皮肤正常。
患者和对照组活检标本真皮上层和下层病变皮肤及非病变皮肤中的肥大细胞数量。
对显微切片的盲法评估显示，几乎仅在受累皮肤中出现真皮水肿以及扩张的淋巴管和血管（所有P <.001，Fisher精确检验）。炎症浸润情况亦是如此，急性荨麻疹患者和迟发性压力性荨麻疹患者标本中的中性粒细胞和嗜酸性粒细胞数量显著增加（各P <.01）。所有荨麻疹患者病变皮肤和未受累皮肤的真皮上层（P <.01）和下层（P <.05）肥大细胞数量均较高，病程超过10周的患者肥大细胞数量进一步增加（P <.01）。水肿和血管变化在寒冷性荨麻疹患者皮肤中最为显著（P <.005），单核细胞浸润在寒冷性荨麻疹、慢性荨麻疹和点刺试验阳性风团患者中更为明显（各P <.05），在迟发性压力性荨麻疹患者的真皮下层中也更为明显（P <.001）。
在所有类型的荨麻疹中，必定存在导致皮肤肥大细胞增多的机制。不同类型的荨麻疹可识别出独特的病理特征，尽管这些特征并无诊断意义。
