犬皮肤红斑狼疮：一项综合性评估（7）-系统性红斑狼疮

王帆

Cutaneous lupus erythematosus in dogs: a comprehensive review
犬皮肤红斑狼疮：一项综合性评估
作者：Thierry Olivry , Keith E. Linder and Frane Banovic


翻译：辛蕾 校对：王帆


Lupus nonspecific skin diseases
非特异性狼疮皮肤病
In the Gilliam-Sontheimer CLE classification, lupus-nonspecific skin diseases are those that are not only present in the context of SLE, but also in other diseases; they do not have histopathology typical of CLE, however.
在Gilliam-Sontheimer皮肤红斑狼疮分类法中，非特异性狼疮皮肤病不仅存在于系统性红斑狼疮，也存在于其他疾病中；然而你，它们没有典型的皮肤红斑狼疮的组织病理学。

Cutaneous lesions associated with systemic lupus erythematosus
系统性红斑狼疮皮肤病变
There is only scant information of skin lesions that occur during canine SLE. In the largest compilations of dogs with SLE, skin lesions were described in 33% to 60% of dogs, while oral ulcers were reported in 4 to 11% of cases, respectively.Of note is that the first paper regrouped data from all cases published beforehand, while, in the other , skin lesions were not described in detail. In the first paper, Scott also reported characteristics on 26 new cases. In these cases, scaling (86% of the 14 dogs with dermatitis), mucocutaneous ulcerations (50%) and footpad ulcers and/or
hyperkeratosis (42%) were most commonly seen; two of 14 dogs (14%) exhibited lesions reportedly consistent with “lupus panniculitis”.
在犬系统性红斑狼疮中少有皮肤病变的报道。在最大的犬系统性红斑狼疮中，30%-60%有皮肤病变，而报道中4%-10%有口腔溃疡。值得注意的是第一篇论文重新整理了所有的病例数据，但在另一篇皮肤病变没有详细描述。在第一篇论文中，Scott也对26个新病例进行了描述。在这些病例中，最常见的是皮屑（患皮炎的14只犬中占86%）、黏膜溃疡（50%）和脚垫溃疡以及/或角化过度（42%）；据报道14只犬有2只（14%）病变与“狼疮脂膜炎”一致。
  
The microscopic lesions reported in 18 of these new cases were most commonly an interface dermatitis with variable inflammation. While vasculitis was reported in only one case, the images of cell-poor interface dermatitis might represent sequelae of a lupus-associated vasculitis, a lupus-nonspecific skin disease; a lymphocytic septal panniculitis was observed in two dogs.
这些新病例中，18例报道了显微镜病变最常见的是不同炎症的界面性皮炎。然而只有一例病例中报道了血管炎，但细胞贫乏的界面性皮炎可能体现了狼疮相关性血管炎（一种非特异性狼疮皮肤病）的后遗症；在两只犬中发现了淋巴细胞性中隔脂膜炎。
  
There is a clear need for more detailed descriptions of skin lesions associated with canine SLE. Future reports should also attempt to classify these lesions in the context of the human and canine CLE subsets described above.
显然需要对犬系统性红斑狼疮的皮肤病变更详细的描述。未来的报道还应尝试在上述人类和犬皮肤红斑狼疮下对这些病变进行分类。

Bullous systemic lupus erythematosus
大疱性系统性红斑狼疮
In 1999, we reported a case that clinically resembled type I bullous SLE of humans (BSLE-I). In this four-year old male castrated bichon frisé, erosions and crusts were present on the right elbow, axilla, thorax, pinna and labial commissures, and ulcers were also discovered on the footpad. Skin biopsies revealed subepidermal vesiculation and immunological testing uncovered skin-fixed and circulating IgG auto-antibodies that targeted type VII collagen in the epidermal basement membrane. As this dog also exhibited an intermittent fever, oral ulcers, a persistent proteinuria, a Coombs’ positive hemolytic anemia, a thrombocytopenia, a suspected pleuritis and hepatitis and elevated serum anti-nuclear autoantibodies, he was diagnosed has having concurrent SLE. The development of skin lesions associated with collagen VII auto-antibodies is normally typical of the disease epidermolysis bullosa acquisita, but, in the context of SLE, the diagnosis should change to type I bullous SLE; as such, BSLE-I is a lupus-nonspecific skin disease.
在1999年，我们报道了一个病例，临床上类似于人类的I型大疱性系统性红斑狼疮(BSLE-I)。在一只四岁已去势雄性比熊犬，右侧肘部、腋下、胸廓、耳廓与唇部连合处存在糜烂和结痂，爪垫上也发现了溃疡。皮肤活检显示表皮下水疱形成，并且免疫学检测发现了表皮基底膜中的靶向VII型胶原蛋白的皮肤固定和循环lgG自身抗体。由于该犬还表现出间歇性发热、口腔溃疡、持续性蛋白尿、库姆斯试验阳性溶血性贫血、血小板减少、疑似胸膜炎和肝炎以及血清抗核自身抗体升高，被诊断为同时患有系统性红斑狼疮。与VII型胶原蛋白自身抗体相关的皮肤病变的发展通常是获得性大疱性表皮松懈症的典型，但在系统性红斑狼疮下，诊断应改为I型大疱性系统性红斑狼疮；因此，I型大疱性系统性红斑狼疮是一种非特异性狼疮皮肤病。

Conclusions
结论
The number of canine CLE variants has increased since the princeps description of FDLE in dogs, nearly 40 years ago. The accumulation of reports has led to the identification of predisposed breeds in many subsets and to a genetic linkage in the case of ECLE. The recognition of additional subtypes of CCLE has revealed the overlap in some common skin lesions, which resemble those of human DLE, (i.e. polymorphic plaques with dyspigmentation, scarring and scaling). The new frontiers of canine CLE investigations will be to characterize and report atypical and crossover CLE variants—which are anecdotally mentioned being seen by colleagues—so that to add to the expanding phenotypic spectrum of canine CLE. Clinician-scientists are also urged to begin delving into the pathogenesis of CLE in dogs, to elucidate the genetic predisposition of the breedspecific variants (e,g. VCLE in collie breeds), the flare factors and the mechanisms of lesion formation. Finally, the usefulness of oral antimalarials for treatment of canine CLE variants should be investigated further.
犬皮肤红斑狼疮变异型自近40年前首次对犬面部型盘状红斑狼疮的描述后数量有所增加。报道的积累导致了识别了许多亚型易感的品种，并且在表皮剥脱型皮肤红斑狼疮病例中形成了遗传连锁。对慢性皮肤红斑狼疮额外亚型的识别显示出一些常见皮肤病变的部分相同，这些病变类似于人类盘状红斑狼疮，（即多形性斑块，伴随着色素沉着异常、瘢痕和皮屑）。犬皮肤红斑狼疮的研究新前沿将是描述和报道非典型性交叉皮肤红斑狼疮变异型—同事们经常提到—以便增加犬皮肤红斑狼疮的表型谱。临床科学家也被促使开始研究皮肤红斑狼疮在犬中的发病机制，以阐明特殊品种（如柯利牧羊犬的水疱型皮肤红斑狼疮）的遗传倾向、发病因素和病变形成机制。最后，应进一步研究口服抗疟药物对于治疗犬皮肤红斑狼疮变异型的疗效。


Abbreviations
简称
ACLE: acute cutaneous lupus erythematosus;
ACLE：急性皮肤红斑狼疮
BP: bullous pemphigoid;
BP：大疱性类天疱疮
BSLEI: type-I bullous systemic lupus erythematosus;
BSLEI：I型大疱性系统性红斑狼疮
CCLE: chronic cutaneous lupus erythematosus;
CCLE：慢性皮肤红斑狼疮
CLE: cutaneous lupus erythematosus;
CLE：皮肤红斑狼疮
DLE: discoid lupus erythematosus;
DLE：盘状红斑狼疮
EBA: epidermolysis bullosa acquisita;
EBA：获得性大疱性表皮松懈症
ECLE: exfoliative cutaneous lupus erythematosus;
ECLE：表皮剥脱型皮肤红斑狼疮
EM: erythema multiforme;
EM：多形红斑
FDLE: facial discoid lupus erythematosus;
FDLE：面部型盘状红斑狼疮
GDLE: generalized discoid lupus erythematosus;
GDLE：全身型盘状红斑狼疮
GSHP: German shorthaired pointer;
GSHP：德国短毛指示犬
LBT: lupus band test;
LBT：狼疮带试验
MCLE: mucocutaneous lupus erythematosus;
MCLE：黏膜皮肤红斑狼疮
MMP: mucous membrane pemphigoid;
MMP：黏膜类天疱疮
SCLE: subacute cutaneous lupus erythematosus;
SCLE：亚急性皮肤红斑狼疮
SLE: systemic lupus erythematosus;
SLE：系统性红斑狼疮
VCLE: vesicular cutaneous lupus erythematosus
VCLE：水疱型皮肤红斑狼疮

王帆

感谢辛蕾同学的精彩翻译~