Zusammenfassung
Die Vitiligo stellt eine Pigmentierungsstörung mit einem assoziierten autoimmun bedingten Verlust von Melanozyten der Epidermis dar. Die Beteiligung humoraler wie auch zellulärer immunologischer Vorgänge wurde untersucht. Wir evaluierten die Rolle proinflammatorischer Cytokine und von Lymphozyten-Subtypen im peripheren Blut bei einer Gruppe österreichischer Patienten mit Vitiligo. Morgens wurden Blutproben von 40 Patienten mit Vitiligo gesammelt. 21 Patienten wiesen eine aktive und 19 eine stabile Krankheitsform auf. Bei allen Patienten bestand eine nicht-segmentale Krankheitsform in unterschiedlicher Ausprägung. 16 Patienten hatten zusätzlich eine autoimmun bedingte Schilddrüsenerkrankung. Um eine Beteiligung proinflammatorischer Cytokine bei Vitiligo zu beurteilen, bestimmten wir sTNF-RI, IL-6 und zusätzlich CIC (zirkulierende Immunkomplexe). Wir verglichen diese Ergebnisse mit den Daten von Normalpersonen. Zur Beurteilung von zellulären Immunvorgängen wurden ein Differentialblutbild und eine Lymphozytentypisierung mittel Durchflusszytometrie erstellt. Die Serum-werte von sTNF-RI, IL-6 und CIC lagen im Normbereich. Der mediane Wert von sTNF-RI in der Patientengruppe betrug 1,5 ng/ml und von CIC 35,2 µg/ml, ein statistisch signifikanter Unterschied zur Kontrollgruppe bestand nicht. Der mediane Wert von IL-6 bei Vitiligopatienten war 2,7 pg/ml und im normalen Bereich gelegen – aber höher als der mediane Wert von 0,5 pg/ml, der bei den Normalpersonen festgestellt wurde (p < 0,001). Absolutund Verhältniswerte der Lymphozytensubtypen waren normal. Das Verhältnis von CD4+/CD8+ T-Zellen wies median einen erhöhten Werte von 2,6 [Quartilabstand 2,0; 3,1] auf. 61 % der Vitiligopatienten hatten einen erhöhten Verhältniswert ober halb des Grenzwertes von 2,4. Bei den meisten Patienten mit Vitiligo erwies sich die Balance von zytotoxischen Suppressorzellen und Helfer T-Zellen im peripheren Blut als gestört, was zu einer Verteilungsstörung der T-Zell-Subtypen am intrakutanen Locus des autoimmunen Melanozytenverlusts führen könnte.
Summary
Vitiligo is a disorder of pigmentation associated with an autoimmune-mediated loss of melanocytes from the epidermis. Humoral immunity and the involvement of cellular immunity have been investigated in the pathogenesis of vitiligo. We evaluated the role of pro-inflammatory cytokines and lymphocyte fractions in peripheral blood in a cohort of Austrian patients with vitiligo. Morning blood samples from 40 patients with vitiligo were collected. Twenty-one patients had active and 19 had stable vitiligo disease. All patients were suffering from non-segmental vitiligo at different stages of the disease. Sixteen persons presented with an additional autoimmune thyroid disease. To evaluate a possible involvement of proinflammatory cytokines in vitiligo we measured sTNF-RI (soluble tumour necrosis factor receptor I), IL-6 and additionally CIC (circulating immune complexes). We compared these findings to the data from matched normal persons. To investigate the mechanisms of cellular immunity, peripheral blood cell count and lymphocyte subtype analysis by flow cytometry were done. sTNF-RI, IL-6 and CIC serum levels were in the normal range. In the patient group median sTNF-RI level was 1.5 ng/ml and median CIC level was 35.2 µg/ml, and no statistically significant differences to the control group were observed. Median IL-6 level in vitiligo patients was 2.7 pg/ml and in the normal range–but higher than the median level of 0.5 pg/ml observed in normal persons (p < 0.001). Absolute and relative counts of lymphocyte subtypes were normal. The ratio of CD4+/CD8+ T-cells had an elevated median value of 2.6 [quartiles 2.0; 3.1]. 61% of the vitiligo patients had a ratio higher than 2.4, which was the normal cut-off point. In most vitiligo patients the balance of cytotoxic/suppressor and helper/inducer T-cells in peripheral blood is disturbed which might lead to a predominance of T-cell subtypes in the intracutaneous site of autoimmune melanocyte loss.
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Pichler, R., Sfetsos, K., Badics, B. et al. Lymphocyte imbalance in vitiligo patients indicated by elevated CD4+/CD8+ T-cell ratio. Wien Med Wochenschr 159, 337–341 (2009). https://doi.org/10.1007/s10354-009-0699-z
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DOI: https://doi.org/10.1007/s10354-009-0699-z