85例重症寻常型天疱疮的临床分析

A clinical analysis of 85 patients with severe pemphigus vulgaris

目的:总结重症寻常型天疱疮患者的临床资料及病情变化,并分析影响糖皮质激素治疗效果的原因并探讨应对方法。方法:对85例重症寻常型天疱疮患者的临床资料及治疗经过进行回顾性分析。结果:85例患者有47例(55.29%)存在病情不易控制,这些患者以复发型(78.72%)为主,未控制组25例(67.57%)长期不规则大剂量使用激素,并发症多,最常见的是皮肤感染(76.60%),其次是低蛋白血症(55.32%)和糖尿病(44.68%)并发率均高于控制组(P <0.05)。早期治疗并发症者皮损控制时间、住院时间、激素使用总量及最大激素维持时间均短于未治疗组(P <0.05)。院内最大糖皮质激素使用量低于院外,皮损控制评分低于院外(P <0.05)。结论:重症寻常型天疱疮患者部分病情反复,足量糖皮质激素不易控制,原因是由于既往长期不规则大剂量使用激素致病情复发加重、继发感染、低蛋白血症和血糖控制不佳而导致对激素敏感性降低,及早发现并予以纠正,对病情的控制有重要意义。

Objective: To summarize the clinical data and disease progression of severe pemphigus vulgaris patients, and to analyze the causes affecting the therapeutic effect of glucocorticoids and investigate the countermeasures. Methods: The clinical data and treatment process of 85 patients with severe pemphigus vulgaris were retro? spective analyzed. Results: Of the 85 patients, 47 (55.29%) had a condition not easy to control, and most (78.72%) of them were recurrent cases. Twenty-five uncontrollable cases (67.57%) irregularly used a high dose of glucocorti? coids for a long time, with many complications;the most common complication was skin infection (76.60%), followed by hypoproteinemia (55.32%) and diabetes mellitus (44.68%);the complication rates were significantly higher than those of the control group (P < 0.05). The patients receiving early treatment for complications had significantly shorter skin lesion control time, hospitalization time, and maximum hormone maintenance time and a significantly lower total hormone dose compared with the untreated patients (P < 0.05). The maximum dose of glucocorticoids and the score of skin lesion control were significantly lower in hospital than outside hospital (P < 0.05). Conclusions: Irreg ular steroid therapy cause relapse and aggravation, secondary infection, hypoproteinemia, and poor blood glucose control, which lead to reduced hormone sensitivity. That is why some of severe pemphigus vulgaris patients relapse easily, even when treated with sufficient glucocorticoids. Early detection and correction have great significance for the control of the disease.