大疱性类天疱疮患者外用糖皮质激素治疗抵抗的相关因素分析

Analysis of the factors related to glucocorticoid-resistance in bullous pemphigoid patients

目的:依据临床和实验室数据,分析大疱性类天疱疮(BP)患者外用糖皮质激素(简称激素)治疗抵抗的相关因素。方法:收集BP患者64例,其中外用激素治疗有效组(即外用激素治疗4周内,连续3 d,每日新发水疱数<3个,以下简称有效组)22例,外用激素治疗无效组(即外用激素治疗4周内皮损未控制,连续3 d,每日新发水疱数≥3个,以下简称无效组)42例。对2组BP患者的皮损类型进行统计,比较2组患者的大疱性类天疱疮疾病面积指数(BPDAI)评分、外周血中白蛋白浓度和嗜酸性粒细胞(EOS)计数以及外周血中抗BP180和抗BP230 IgG抗体、总IgE、抗BP180和抗BP230 IgE抗体浓度。结果:有效组患者的皮损以单纯水疱为主(68%),无效组则以红斑水疱为主(63%)。无效组患者的BPDAI评分、EOS计数、总IgE、抗BP180 IgG抗体、抗BP230 IgG抗体浓度及抗BP230 IgE抗体浓度均较有效组患者明显增高,差异具有统计学意义(P<0.05);而2组患者白蛋白水平及抗BP180 Ig E抗体浓度无明显差异。结论:除BPDAI评分及特异性IgG水平之外,还可根据BP患者的皮损类型、外周血EOS计数、总IgE及抗BP230 IgE抗体的水平指导BP患者治疗方法的选择。

Objective: To analyze the factors related to the resistance of topical glucocorticoid treatment in bullous pemphigoid(BP) patients using clinical and laboratory data. Methods: A total of 64 BP patients were enrolled in the study and were divided into two groups based on their responses to topical glucocorticoid treatment. Group 1, referred to as effective group, contained 22 patients, who had less than 3 new blisters in the continuous 3 days during 4 weeks of the topical treatment, and had showed good responses to the treatment. Group 2, referred to as ineffective group, contained 42 patients who had more than 3 new blisters in the continuous 3 days during 4-week treatment, and showed resistant to the treatment. The types of lesions, the bullous pemphigoid disease area index(BPDAI) score, the concentration of albumin, eosinophil counts, the titer of anti-BP180 IgG, anti-BP230 IgG, the concentration of total IgE, the titer of anti-BP180 as well as anti-BP230 IgE of the two groups were compared and analyzed. Results: The lesions of the patients in effective group were mostly simple blister(68%),and the lesions of the patients in ineffective group were blisters with erythematous base(63%). The BPDAI, EOS counts, the concentration of total IgE, the titer of anti-BP180 IgG, anti-BP230 IgG, and anti-BP230 IgE were significantly higher in the patients of ineffective group than those of effective group(P<0.05). There were no differences on the concentration of albumin and the titer of anti-BP180 IgE between these two groups. Conclusion: In addition to BPDAI and anti-BP180 IgG titer, we can use other factors such as the type of blisters, peripheral eosinophil counts, the concentration of total IgE, as well as the titer of anti-BP230 Ig E to help guide appropriate treatment in BP patients.