Background.Urticarialvasculitis（UV）isanuncommontypeofchronicurticaria（CU）,whichexhibitsleucocytoclasticvasculitis.Painfulandlong-lasting（>24h）wealsassociatedwithpurpuraorbruisingareconsideredindicativeofUV.Itisoftenresponsivetooralcorticosteroidsandpoorlytooralantihistamines.Hypocomplementaemiaandsystemicinvolvementarealsocommonlyreported.Aims.TodiagnosepatientswithUVhistologicallyandthencomparetheirclinicalfeaturesandresponsetovarioustreatmentregimens.Methods.Biopsiesweretakenfrom312subjectswithCUunresponsivetooralantihistamines;ofthese,47werehistologicallydiagnosedashavingUV.Biopsiesweretakenirrespectiveoftheclinicalfeaturesofwealeruption.Otherdiseasesknowntobeassociatedwithsmall-vesselvasculitishadpreviouslybeenexcluded.Results.Individualwealslasted<24hin57.4%ofpatients,andpainortendernesswasreportedonlyby8.6%.Extracutaneousfeatureswerepresentin81%,hypocomplementaemiain11%andabnormalitiesofotherlaboratoryparameters（i.e.raisederythrocytesedimentationrate,microscopichaematuria）in76.6%.Hydroxyzinewaseffectiveinonlyonepatient.Bothoralcorticosteroidsandcinnarizinewereeffectiveinahighpercentageofthepatients.Conclusion.Thisdiagnosticapproachallowedustoidentifyalargegroup（47patients）withUV.Mostdidnotpresenttheclinical（prolongeddurationofwealsandbruising）andlaboratoryfeaturesthathavepreviouslybeendescribedascharacteristicofUV.Cinnarizinewasfoundtobeavaluabletreatmentoption.背景：荨麻疹性血管炎（UV）是慢性荨麻疹（CU）的一种不常见的类型，表现为白细胞破碎性血管炎。疼痛和持续时间长（>24h）的风团，且伴有紫癜或青肿被认为是UV的指示性体征。UV通常对口服皮质类固醇治疗有反应，但对于口服抗组胺药反应较差。UV患者中常见低补体血症和全身系统受累的报道。目的：对UV的患者行组织学诊断，并比较他们的临床特征以及对不同治疗疗法的反应。方法：对口服抗组胺药无反应的312例CU患者行活检。在这些患者中，有47例组织学诊断为UV。我们进行活检时未考虑风团皮疹的临床特征。患有其他已知与小血管的血管炎症有关的疾病的患者在此前已被排除。结果：57.4％的患者风团持续时间<24小时，只有8.6％患者有疼痛或压痛。81％患者有皮肤外的临床表现，11％有低补体血症，76.6％患者有其他实验室参数异常（如红细胞沉降率增高，显微镜下血尿）。羟嗪仅对1例患者有效。口服皮质类固醇和桂利嗪治疗对大多数患者均有效。结论：这一诊断方法（组织学检查活检）使我们可以鉴别出患有UV的一个大群体（47位患者）。一些曾被描述为是UV特有的临床特征（持续时间较长的风团和青肿）及实验室特征，在大多数患者中并未表现出来。我们发现桂利嗪是一个有价值的治疗UV的选择。专家评价：AlexanderMarslandUniversityofManchesterMedicalSchool,UnitedKingdomDermatologyThisstudydemonstratesthatpatientswithchronicurticariarefractorytotreatmentwithantihistaminesmayhavehistologicallyprovenurticarialvasculitis（UV）despitehavingnoclinicalsymptomsorlaboratoryfeaturessuggestiveofthis.TheauthorsalsoreportedthatcinnarizinewasfrequentlyausefultreatmentforUV.Whenconsideringmanagementofpatientswithchronicurticaria,acarefulhistoryhastraditionallybeensoughttoidentifythosewhomayhaveUV.Examinationforextracutaneousfeaturesandlaboratoryexaminationssuchaserythrocytesedimentationrate（ESR）andurinalysisarealsoperformed.Askinbiopsyisthenundertakentoconfirmthediagnosis,andthisisusefulasthesepatientsmaybeatincreasedriskofhavingassociatedfeaturesandtendtorespondbettertodifferenttreatmentprotocolsthanthoseusedwithpatientswith'standard'chronicspontaneousurticaria.Thestudyisretrospectivebutincorporatesgoodnumbers（312patients,ofwhich47hadUV）.Theirreportofthesuccessofcinnarizineaddstoearliercasereports,butadouble-blindedrandomizedcontrolledstudyshouldbeundertakentocompareitwithothertreatmentmodalities.FurtherresearchisalsorequiredtoinvestigatethepathogenesisanddetermineonceandforallwhetherUVisamoresevereform（s）ofthesamecondition（s）asotherurticariasorwhetherithasaseparateaetiology.