寻常型银屑病合并大疱性类天疱疮11例临床分析  

Clinical analysis of 11 patients with psoriasis vulgaris complicated with bullous pemphigoid

作　　者：赵芬[1] 胡彬[1] 吴卓璇[1] 万立 叶军 罗红玉 方美珍 周小勇[1] 陈柳青[1] 陈金波[1] ZHAO Fen;HU Bin;WU Zhuoxuan;WAN Li;YE Jun;LUO Hongyu;FANG Meizhen;ZHOU Xiaoyong;CHEN Liuqing;CHEN Jinbo(Dept.of Dermatology,Wuhan No.1 Hospital,Wuhan 430022,Hubei,China;Dermatology Hospital of Southern Medical University,Guangzhou 510091,Guangdong,China;Community Health Service Center,Zhonghua Road Street,Wuchang District,Wuhan 430061,Hubei,China)

机构地区：[1]武汉市第一医院皮肤科,湖北武汉430022 [2]南方医科大学皮肤病医院,广东广州510091 [3]武昌区中华路街社区卫生服务中心,湖北武汉430061

出　　处：《武汉大学学报（医学版）》2023年第4期503-508,共6页Medical Journal of Wuhan University

基　　金：米尔斯坦亚美医学基金会皮肤病研究项目基金(MMAAP,2018年);湖北省卫生健康委科研基金资助(编号:WJ2021M002);武汉市卫生局课题(编号:WX12A12)。

摘　　要：目的:总结寻常型银屑病合并大疱性类天疱疮(BP)患者的临床特征及治疗方法。方法:回顾分析武汉市第一医院2012至2021年11例寻常型银屑病合并BP的临床特征、实验室检查结果、治疗及预后。结果:11例寻常型银屑病合并BP患者中,其中男9例,女2例,平均年龄(67.73±13.06)岁,银屑病均先于BP发病,平均间隔时间为(15.95±13.17)年。11例BP均发生在外观正常的皮肤或红斑上。5例有明确窄谱中波紫外线光疗史,8例直接免疫荧光检查阳性,6例患者检测BP180抗体均为阳性,4例患者检测BP230抗体仅1例阳性,8例给予系统糖皮质激素和/或免疫抑制剂治疗,3例给予四环素类、烟酰胺及局部外用激素治疗,其中1例给予免疫球蛋白冲击治疗。随访半年至6年,8例患者无新发水疱,银屑病局限性复发,3例死亡。结论:寻常型银屑病合并大疱性类天疱疮临床相对少见,中老年男性多见,中重度患者给予糖皮质激素和或免疫抑制剂治疗有效,控制病情后先对糖皮质激素规律减量,较少引起银屑病加重。Objective:To summarize the clinical features and treatment of patients with psoriasis vulgaris complicated with bullous pemphigoid(BP).Methods:The clinical data including laboratory test,treatment and follow-up records of the patients diagnosed as psoriasis vulgaris complicated with BP in Wuhan No.1 Hospital from 2012 to 2021 were analyzed retrospectively.Results:Eleven cases of psoriasis vulgaris with BP were found,including 9 males and 2 females,with an average age of(67.73±13.06)years.Psoriasis onset preceded BP in all the patients.The average disease duration of psoriasis was(15.95±13.17)years.The bullous lesions occurred on the normal skin or erythema in 11 patients.Five patients received narrow-band ultraviolet B therapy.Eight patients were positive in direct immunofluorescence.Six patients showed positive anti-BP180 antibodies,and one of the four patients who tested anti-BP230 antibodies was positive.Eight patients were treated with corticosteroids and/or immunosuppressive agents,and three cases were treated with tetracycline combined with niacinamide and topical corticosteroid.One case received high-dose intravenous immunoglobulin treatment.During the follow-up ranged from a half year to six years,three cases died,and no new blister lesions occurred and psoriatic lesions remained in the survived eight patients.Conclusion:Psoriasis vulgaris complicated with BP were rare and mainly affects the elderly.Corticosteroids combined with immunosuppressants were effective for treating moderate to severe psoriasis vulgaris complicated with BP.When the disease is under control,tapering the dosage of corticosteroids firstly according to the treatment strategy of BP will less worsen psoriasis.

关 键 词：寻常型银屑病 大疱性类天疱疮 回顾性分析 

分 类 号：R758.63[医药卫生—皮肤病学与性病学]