Hong Kong Dermatology & Venereology Bulletin

Volume 12 Number 1, Spring 2004

'Measuring' eczema in children: what actually are we measuring?

EKL Hon 韓錦倫, TF Leung 梁廷勳, TF Fok 霍泰輝

The disease activity and severity of atopic dermatitis (AD) may be measured clinically and biochemically. There are at least thirteen clinical scoring systems for the assessment of disease severity in AD. Each system has its problems with inter-observer and intra-observer variability. They focus on the various symptoms and signs of this chronically relapsing disease. There are also various non-specific biochemical markers of disease severity. The markers for type 1 T helper (Th1) lymphocyte-mediated immunity, usually associated with infective process, are depressed in AD and their levels may be altered with eczema treatment whereas Th2 markers are associated with allergic inflammation and may be elevated in AD. Interleukin-18, a pleiomorphic marker, plays important roles in both Th1 and Th2 immunity. Cutaneous T cell-attracting chemokine (CTACK), on the other hand, is a skin-specific chemoattractant cytokine which may correlate with AD severity and obviate the issue of observer reliability. We share our experience in some of these markers and discuss the potential clinical significance of their measurement. (H.K. Dermatol. Venereol. Bull. (2004) 12, 6-11)

異位性皮炎病情的輕重和活躍性可以透過臨床或生物化學的方法去評估。臨床上最少有十三個評估 計分系統用於評估異位性皮炎病情的輕重,但每個系統均各有其不足,存在著不同評估者之間及同 一評估者不同評估時間之間的差異。這些系統著眼於此症的症狀和體徵。此外,有很多非特異性的 生化標記物可反映病情的輕重。一型輔助性T 淋巴細胞仲介免疫反應(Th1)的標記物通常伴隨感染發 生,在異位性皮炎患者中水平下降,並隨治療有所改變,另一方面,二型輔助性T 淋巴細胞仲介免 疫反應(Th2)的標記物則伴隨過敏性炎症發生,在異位性皮炎患者中水平升高。白血球介素-18 為一 多形標記物,對一型及二型輔助性T 淋巴細胞仲介免疫反應均起重要作用。皮膚T 淋巴細胞吸引趨 化因子(CTACK)為皮膚特異性化學吸引細胞因子,能客觀反影異位性皮炎病情輕重,避免評估者的 主觀判斷差異。我們將討論這些標記物的潛在臨床意義及其衡量方法。

Keywords : Atopic dermatitis, CTACK

關鍵詞:異位性皮炎,皮膚T 淋巴細胞吸引趨化因子

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