自身免疫性水疱病患者新型冠状病毒感染临床特征  

Clinical features of coronavirus disease 2019 in patients with autoimmune blistering diseases

作　　者：朱鑫宇 潘晓媛 杨海晶[1] 王飞[1] 董正邦[1] Zhu Xinyu;Pan Xiaoyuan;Yang Haijing;Wang Fei;Dong Zhengbang(Department of Dermatology,Zhongda Hospital,Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院皮肤科,南京210009

出　　处：《中华皮肤科杂志》2023年第11期1023-1027,共5页Chinese Journal of Dermatology

摘　　要：目的分析自身免疫性水疱病(AIBD)患者新型冠状病毒感染的临床特征,探讨AIBD患者发生重症新型冠状病毒感染的相关因素。方法回顾性分析2021年8月至2022年12月于东南大学附属中大医院住院治疗的AIBD患者的一般临床资料。采用独立样本t检验、Mann-Whitney U检验或χ^(2)检验(Fisher精确检验)分析AIBD患者发生重症新型冠状病毒感染的相关因素。结果共纳入30例感染新型冠状病毒的AIBD患者,年龄(62.90±15.72)岁,男性16例,女性14例;AIBD疾病谱以寻常型天疱疮(12例,40.00%)和大疱性类天疱疮(13例,43.33%)为主。新型冠状病毒感染的常见临床表现为咳嗽(25例,83.33%)、乏力(22例,73.33%)和发热(15例,50.00%);大部分患者的临床症状较轻,7例(23.33%)发展为重症,其中30~59岁患者14例中2例发展为重症;60岁及以上老年患者16例中5例发展为重症,2例死亡。根据新型冠状病毒感染临床分型标准,分为轻中型组(23例)和危重型组(7例);危重型组AIBD病程[(10.71±10.72)个月]显著短于轻中型组[(27.61±19.67)个月,t=2.16,P=0.040];轻中型组AIBD缓解率(21/23)高于危重型组(4/7,χ^(2)=4.36,P=0.037);轻中型组患者近1个月内每日甲泼尼龙平均使用量[M(Q1,Q3),8(4,14)mg]与危重型组患者[24(12,47)mg]比较差异有统计学意义(U=133.50,P=0.007),危重型组平均用量>8 mg患者比例(6/7)高于轻中型组(8/23,χ^(2)=5.59,P=0.031)。结论AIBD合并新型冠状病毒感染患者中,高龄患者的重症发生率和死亡率较青壮年高,AIBD病程较短、AIBD未缓解、近1个月内每日甲泼尼龙平均使用量>8 mg是AIBD患者感染新型冠状病毒后发展为重症的危险因素。Objective To analyze clinical features of coronavirus disease 2019 in patients with autoimmune blistering diseases(AIBDs),and to explore risk factors for the development of severe coronavirus disease 2019 in patients with AIBDs.Methods Clinical data were collected from patients with AIBDs who were hospitalized in Zhongda Hospital,Southeast University from August 2021 to December 2022,and were retrospectively analyzed.Independent sample t-test,Mann-Whitney U test,or chi-square test(Fisher′s exact test)were used to analyze factors associated with severe coronavirus disease 2019 in AIBD patients.Results A total of 30 patients with AIBDs accompanied by coronavirus disease 2019 were included,they were aged 62.90±15.72 years,and included 16 males and 14 females;pemphigus vulgaris(12 cases,40.00%)and bullous pemphigoid(13 cases,43.33%)predominated in the disease spectrum of AIBDs in these patients.The common clinical manifestations of coronavirus disease 2019 were cough(25 cases,83.33%),fatigue(22 cases,73.33%),and fever(15 cases,50.00%);most patients had mild clinical symptoms,while 7(23.33%)developed into severe coronavirus disease 2019,including 2 out of 14 aged 30-59 years and 5 out of 16 elderly patients aged≥60 years,and 2 out of the 5 elderly patients finally died.According to the clinical classification criteria of coronavirus disease 2019,the 30 patients were divided into the mild-to-moderate group(23 cases)and severe group(7 cases);the duration of AIBDs was significantly shorter in the severe group(10.71±10.72 months)than in the mild-to-moderate group(27.61±19.67 months,t=2.16,P=0.040);the remission rate of AIBDs was significantly higher in the mild-to-moderate group(21/23)than in the severe group(4/7,χ^(2)=4.36,P=0.037);the average daily dosage of methylprednisolone during the last month was significantly lower in the mild-to-moderate group(M[Q1,Q3]:8[4,14]mg)than in the severe group(24[12,47]mg,U=133.50,P=0.007),and the proportion of patients treated with methylprednisolone at an average dosage of>8

关 键 词：皮肤疾病 水疱大疱性 自身免疫疾病 危险因素 新型冠状病毒感染 临床特征 

分 类 号：R758.2[医药卫生—皮肤病学与性病学] R511[医药卫生—临床医学]