银屑病并发免疫性大疱性皮肤病11例临床分析

Clinical analysis on 11 patients with psoriasis vulgaris coexisted with autoimmune bullous diseases

目的:对银屑病并发免疫性大疱性皮肤病患者的临床相关因素及其临床特征进行回顾性分析。方法:收集11例银屑病并发免疫性大疱性皮肤病患者资料,对其临床特征、大疱病的诱发因素、免疫病理以及治疗等方面进行回顾性分析;并对部分患者的特异性致病性抗体进行检测。结果:11例患者中1例为女性,10例为男性,平均年龄(70.55±11.08)岁。患者在银屑病发生后平均(15.36±9.19)年出现大疱性皮肤病;4例患者在出现大疱病前有明确的窄谱中波紫外线(NB-UVB)照射史。7例患者并发天疱疮,4例并发类天疱疮。7例天疱疮患者中4例免疫荧光检查阳性,而阴性的2例患者中外周血检出高滴度抗Dsg1抗体,另有1例结果不详;4例类天疱疮患者中3例患者免疫荧光检查阳性,2例患者抗BP180抗体阳性。这些患者应用小剂量糖皮质激素联合免疫抑制剂,对并发的免疫性大疱病均有较好疗效,对原有的银屑病亦有一定的疗效。结论:银屑病并发免疫性大疱性皮肤病临床上较为罕见,对该病的正确认识,有助于早期合理的临床治疗,尽早控制病情。

Objective： To analyze the clinical features, relevant factors of the patients with psoriasis vulgaris coexisted with autoimmune bullous disease. Methods： 11 patients with psoriasis vulgaris coexisted with autoimmune bullous disease were col- lected, and retrospectively analyzed on clinical manifestations, triggering factors, pathological features and the treatment of them. The specific antibodies were also detected. Results： Among the patients, the ratio of male to female was 10：1. The average age was 70.55±11.08 years old. The average disease duration of psoriasis was 15.36±9.19 years. Four patients had a definite NB-U- VB therapy before. Seven patients were diagnosed as pemphigus, among which four showed positive IF, two negative but had high titers of anti-Dsgl antibody. Four patients were diagnosed as pemphigoid, among which three showed positive IF, two had high titers of anti-BP180 antibody. Low-dose glucocorticoids combined with immunosuppressive agents were used for the treat- ment. Conclusions： It is not common for the patients with psoriasis coexsisted with autoimmune bullous disease. We should make the diagnosis earlier and provide a proper treatment for these patients.