CD69、CD107a在迟发型药物变态反应患者外周 - 第三军医大学学报和目的.docVIP

PBMC表面分子CD69、CD107a表达上调在诊断迟发型药物变态反应中的意义 牛军，钟华，宋志强，钟白玉，郝飞 （第三军医大学西南医院皮肤科，重庆 400038） 摘 要：目的 检测药疹患者外周血单个核细胞表面分子CD69和CD107a的表达，评价其与迟发型药物变态反应的相关性。方法 采用流式细胞术分别检测经致敏药物刺激72小时后20例药疹患者和10例健康对照者外周血单个核细胞表面CD69和CD107a分子的表达。 结果 经致敏药物刺激的药疹患者外周血单个核细胞表面CD69和CD107a表达明显增高，和健康对照组、药疹未刺激组比较有统计学差异（Ｐ＜0.01）,且随着致敏药物浓度的增加，CD69和CD107a的表达呈剂量依赖性上调。 结论 药疹患者外周血单个核细胞经致敏药物刺激后CD69、CD107a表达明显增加，可望成为确定药疹患者致敏药物的生物标志。 [【关键词] 】CD69；CD107a；药物变态反应；PBMC Significance of CD69 and CD107 upregulation on PBMC for delayed-type drug hypersensitivity Niu Jun, Zhong Hua, Song Zhiqiang, Zhong Baiyu, Hao Fei Department of Dermatology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China Abstract: Objective To analyze the expression of CD69 and CD107a on peripheral blood mononuclear cell（PBMC）in patients with drug rash and explore the relationship between these two moleculars and delayed drug hypersensitivity. Methods PBMC obtained from 20 patients and 10 healthy controls were incubated with culprit drugs for 72 hours, and the expression of CD69 and CD107a was analyzed by ?ow cytometry. Results The expression of CD69 and CD107a on PBMC was significant increased in culprit drugs stimulated group compared with that in un-stimulated group and healthy control group (P0.01), and their expression in a dose dependent. Conclusion CD69 and CD107a were highly expressed on PBMC of patients with drug rash, suggesting that these two molecules are expected to be candidate biomarkers for determination of the culprit drugs for delayed drug hypersensitivities in vitro. Keywords: CD69; CD107a; drug hypersensitivity; PBMC 药物过敏十分常见，大约占所有药物不良反应的15%[1]，皮肤是最易受累也最易观察的靶器官，肝、肾等重要脏器也可受累甚至危及生命。80%以上的药物过敏为迟发型变态反应，主要由T淋巴细胞介导[2]。由于各种药物引起的变态反应潜伏期长短不一，且可能同时服用多种药物，还有食物、环境等多种因素干扰，给临床医生确定致敏药物带来一定的困难。早期研究提出安慰剂对照的双盲药物激发实验是诊断药物变态反应的金标准，但由于潜在的风险和伦理学考虑难以在临床开展[3]。体内实验如药物斑贴试验、点刺试验和皮内试验阳性率低[4]，技术方法尚不成熟。新近研究表明药物特异性细胞毒性T淋巴细胞（cytotoxic T cell，CTL）在迟发型药物变态反应的发病机制中起关键作用，因此以检测药物特异性T淋巴细胞活化为原理的一些体外试验更有应用前景。 表面分子CD69是T淋巴细胞早期活化的标志，当