新疆地区合并瘙痒的大疱性类天疱疮患者临床特点分析

Analysis of clinical characteristics of bullous pemphigoid patients with itching in Xinjiang

目的总结合并瘙痒的大疱性类天疱疮(bullous pemphigoid,BP)患者的临床诊治经验,归纳疾病特点,为诊疗提供借鉴。方法收集196例合并瘙痒的BP住院患者临床资料,回顾性分析其一般情况、临床表现、辅助检查、治疗方法、误诊情况、合并症及转归。结果(1)本病好发于老年患者,平均年龄在(70.69±15.40)岁,男性略多于女性,瘙痒可为本病首发症状,且以中度瘙痒最为常见;(2)诊断需通过临床表现、实验室检查及组织病理学检查综合判定,直接免疫荧光检查具有更为重要的诊断价值;(3)糖皮质激素控制皮损的最大剂量(相当于等量泼尼松),在轻度、中度、重度患者中的平均值分别为:(23.33±11.75)mg/d,(36.19±14.36)mg/d,(41.48±13.99)mg/d。结论中老年患者皮肤瘙痒伴有紧张性水疱或大疱,应考虑大疱性类天疱疮,需进行组织病理学和直接免疫荧光检查以明确诊断。激素联合免疫抑制剂治疗较单用激素治疗并发症相对较少,病情控制更快,度普利尤作为BP新型治疗药物对于病情控制及生活质量的提高有较好的疗效。

Objective To summarize the clinical diagnosis and treatment experience of bullous pemphigoid(BP)patients with itching,summarize the characteristics of disease,and provide reference for diagnosis and treatment.Methods Clinical data of 196 hospitalized BP patients with itching were collected,and their general condition,clinical manifestations,auxiliary examinations,treatment methods,misdiagnosis,comorbidities,and outcomes were retrospectively analyzed.Results①This disease is more common in elderly patients,with an average age of(70.69±15.40)years.Men are slightly more than women,and itching can be the first symptom of this disease,with moderate itching being the most common symptom;②Diagnosis needs to be comprehensively judged through clinical manifestations,laboratory tests,and histopathological examinations,and direct immunofluorescence examination has more important diagnostic value;③The maximum dose of glucocorticoid for controlling skin lesions(equivalent to an equivalent dose of prednisone)is(23.33±11.75)mg/d,(36.19±14.36)mg/d,and(41.48±13.99)mg/d,respectively,in mild,moderate,and severe patients.Conclu⁃sion In middle-aged and elderly patients with skin itching accompanied by tension blisters or bullae,bullous pemphigoid should be considered,and histopathology and direct immunofluorescence examination should be performed to clarify the diagnosis.The combination of hormone therapy and immunosuppressive agents has relatively fewer complications and faster disease control compared to hormone therapy alone.As a new treatment drug for BP,Dupilumab has good therapeutic effects on disease control and it can improve quality of life.