曾令斌 陆捷洁 吴伟伟 韩秋月 王爱民

[摘要]目的：探討马拉色菌感染对寻常型银屑病（Psoriasis vulgaris，PV）患者血清P物质（Substance P，SP）、Th1/Th2有关因子的影响及与病情关联性。方法：选取2017年4月-2019年10月笔者科室就诊的62例马拉色菌感染PV患者为感染组，同期62例未感染马拉色菌PV患者为未感染组。对比两组患者一般资料、血清SP、Th1/Th2有关因子[白细胞介素-10（Interleukin-10，IL-10）、白细胞介素-4（Interleukin-4，IL-4）、白细胞介素-2（Interleukin-2，IL-2）、干扰素-γ（Interferon-γ，INF-γ）、肿瘤坏死因子-α（Tumor necrosis factor-α，TNF-α）]水平，Spearman相关系数分析马拉色菌感染与患者血清SP、Th1/Th2有关因子表达的关联性，并比较不同马拉色菌密度感染患者病情程度，分析马拉色菌密度与病情程度的相关性。结果：感染组血清SP、Th2有关因子水平高于未感染组，血清Th1有关因子水平低于未感染组（P<0.05）;感染组病情程度为重度患者马拉色菌密度显著高于中度、轻度患者（P<0.05）;血清SP、Th2有关因子水平与马拉色菌感染呈正相关，血清Th1因子水平与马拉色菌感染呈负相关，马拉色菌密度与感染组患者病情程度呈正相关（P<0.05）。结论：马拉色菌感染PV患者存在血清SP、Th1/Th2有关因子异常波动情况，其机制可能是马拉色菌感染后引起的免疫异常，进一步增加马拉色菌增殖活性，加重病情，临床可根据上述因子表达情况制定治疗方案。

[关键词]马拉色菌;寻常型银屑病;P物质;Th1;Th2;白细胞介素-4;干扰素-γ

[中图分类号]R758.63    [文献标志码]A    [文章编号]1008-6455（2021）07-0058-04

Effect of Malassezia Infection on Serum SP， Th1/Th2 Related Factors in Patients with Psoriasis Vulgaris and Its Correlation with the Disease

ZENG Ling-bin， LU Jie-jie， WU Wei-wei， HAN Qiu-yue， WANG Ai-min

[Department of Dermatology Ward 1， Hainan Provincial Dermatology Hospital （Hainan Provincial Center for Dermatology and Venereal Disease Control）， Haikou 570000， Hainan，China]

Abstract： Objective  To investigate the effect of Malassezia infection on substance P （SP） and Th1/Th2 related factors in patients with psoriasis vulgaris （PV） and their relationship with disease. Methods  From April 2017 to October 2019， 62 patients with PV infected with Malassezia in our hospital were selected as the infection group， and 62 patients without PV infected with Malassezia were selected as the uninfected group in the same period.Compare the general information of two groups， serum SP， Th1/Th2 related factors [Interleukin-10 （IL-10）， Interleukin-4 （IL-4）， Interleukin-2 （IL-2）， Interferon-γ （INF-γ）， Tumor necrosis factor-α （TNF-α）] levels of the two groups.Spearman correlation coefficient analysis of the correlation between Malassezia infection and the expression of SP， Th1/Th2 related factors in patients' serum，the disease severity of patients with different Malassezia density infections was compared， and the correlation between the density of Malassezia bacteria and the disease severity was analyzed. Results  The levels of serum SP and Th2 related factors in the infected group were higher than those in the uninfected group， and the levels of serum Th1 related factors were lower in the uninfected group （P<0.05）.The severity of the infection group was that the density of malassezia in severe patients was significantly higher than that of moderate and mild patients （P<0.05）.The levels of serum SP and Th2 related factors were positively correlated with Malassezia infection， the serum Th1 factor levels were negatively correlated with Malassezia infection， and the density of Malassezia bacteria was positively correlated with the disease severity of patients in the infection group （P<0.05）. Conclusion  The abnormal fluctuations of serum SP and Th1/Th2 related factors in patients with PV infected by Malassezia may be caused by the immune abnormality after Malassezia infection，it may further increase the proliferation activity of Malassezia and aggravate the disease，clinical treatment can be formulated according to the expression of the above factors.

Key words： malassezia; psoriasis vulgaris; substance P; Th1; Th2; Interleukin-4; Interferon-γ

目前，寻常型银屑病（Psoriasis vulgaris，PV）发病机制尚未明确，有研究认为，可能与多种炎性因子大量聚集在组织皮损处诱发局部炎症、免疫损害有关[1-2]。此外，还有研究显示，真菌可作为超抗原或交叉抗原介导PV发生、发展过程，常见真菌为马拉色菌[3]。马拉色菌是寄生在正常人体皮肤的一种嗜脂性酵母菌，若宿主皮肤微环境异常改变或防御功能减弱，马拉色菌可大量繁殖并诱发多种皮肤疾病，其致病机制源自菌体分解细胞脂质引起细胞形态学改变、凋亡，且可通过影响机体Th细胞亚群分化诱发免疫损害，加重皮肤疾病[4-5]。本研究通过探究马拉色菌感染对PV患者血清P物质（Substance P，SP）、Th1/Th2有关因子的影响及与病情关联性，旨在为临床病情评估、完善治疗方案提供参考。……