大疱性类天疱疮227例回顾性临床分析  

Retrospective analysis of 227 patients with bullous pemphigoid

作　　者：高涛[1] 龙娟 吕静[1] 杜宇[1] 邓小蓉[1] 张钟[1] 刁庆春[1] GAO Tao;LONG Juan;LV Jing;DU Yu;DENG Xiao-rong;ZHANG Zhong;DIAO Qing-chun(Department of Dermatology,Traditional Chinese Medicine Hospital,the First People's Hospital of Chongqing,Chongqing 40001,China)

机构地区：[1]重庆市中医院重庆市第一人民医院皮肤科,重庆400011

出　　处：《临床皮肤科杂志》2019年第1期6-9,共4页Journal of Clinical Dermatology

基　　金：重庆市皮肤病临床医学研究中心项目(cstc2015yfpt_gcjsyjzx120014)资助

摘　　要：目的:总结大疱性类天疱疮(BP)的临床特点及治疗经验,为本病的诊疗提供借鉴。方法:回顾227例BP住院患者临床资料,分析其一般情况、临床表现、辅助检查、治疗方法、疗效、误诊与复发情况及合并症。结果:(1)男女发病比例为1.2∶1,平均发病年龄为(72.6±11.0)岁;(2)8.4%的患者伴有口腔黏膜受累,45.9%患者发病1个月以上才出现典型的水疱或大疱;(3)直接免疫荧光检查阳性率高于间接免疫病理检查阳性率,分别为94.8%和75.9%;(4)皮损程度越重,控制症状需要的糖皮质激素量越大;(5)发病早期误诊率>50%,非大疱期最易误诊为湿疹,大疱期最易误诊为单纯疱疹或带状疱疹;(6)24.3%的BP合并神经系统疾病,与对照组比较差异有统计学意义。结论:(1)对老年初发湿疹样皮疹患者应尽早行皮损组织病理检查及免疫病理检查,排除BP;(2)糖皮质激素治疗BP时起始需足量,缓慢减量;(3)避免神经系统疾病的危险诱发因素可能会降低BP的发病率。Objective: To summarize the clinical characteristics and treatments of bullous pemphigoid(BP) in order to provide reference for the diagnosis and treatment of this disease. Methods: The clinical data, including the general information,clinical manifestations, auxiliary examination, therapeutic methods and efficacy, misdiagnosis, recurrence and complication were analyzed in 227 cases of BP inpatients. Results:(1)The ratio of male to female was 1.2∶1;The average age of onset was72.6±11.0 years old.(2) 8.4% of patients were accompanied by oral mucosal involvement, while 45.9% of patients had typical skin blisters or bullae for over a month.(3)The positive rate of direct immunofluorescence was higher than that of indirect immunofluorescence(94.8% versus 75.9%).(4)The severer the skin lesion, the higher dose of glucocorticoids was required to control the symptoms.(5)The misdiagnosis rate was >50% in earlier stage of BP. Disease in non-bullous phase was the easiest to be misdiagnosed as eczema, while in bullous stage, was the most likely to be misdiagnosed as herpes simplex/herpes zoster.(6)BP with nervous system diseases accounted for 24.3%, which was significantly higher than controls. Conclusions:(1)Pathological examination should be given to the elderly patients with primary eczematous lesions in order to exclude BP.(2)When glucocorticoids is used, it is ideally to start with sufficient dose and to lower dose slowly.(3)Avoidance of risk factors associated with the nervous system diseases may lower the incidence of BP.

关 键 词：类天疱疮 大疱性 回顾性分析 糖皮质激素 

分 类 号：R758.66[医药卫生—皮肤病学与性病学]