伴脑卒中的大疱性类天疱疮74例临床分析

A clinical analysis of 74 cases of bullous pemphigoid with stroke

目的探讨伴有脑卒中的大疱性类天疱疮(BP)患者与不伴脑卒中者临床特征的差异及其与脑卒中预后的关系。方法回顾分析2012年9月至2020年4月郑州大学第一附属医院住院的BP患者病历资料,按其是否伴有脑卒中分为BP+脑卒中组(BP+ST组)、BP-ST组,对比两组的临床表现及相关实验室检查指标;依据改良Rankin量表(mRS)对卒中结局的评分将BP+ST组分为预后良好组(mRS≤2分)、预后不良组(mRS>2分),并对临床表现及相关实验室检查结果进行亚组间比较;对年龄、病程及实验室检查结果等计量资料与mRS评分进行相关性分析。结果BP-ST组256例,男151例,女105例,年龄19~92(66.8±13.6)岁;BP+ST组74例,男45例,女29例,年龄48~92(74.6±9.6)岁。BP+ST组较BP-ST组年龄大(t=-5.57,P<0.001),BP病程短(Z=-3.07,P=0.002)。两组皮损分布差异有统计学意义(χ^(2)=10.51,P=0.015),BP+ST组皮损泛发比例低(P<0.05),累及四肢者比例高(P<0.05),抗BP180 IgG抗体水平高[215.0(157.2,283.1)U/ml比155.0(63.9,279.8)U/ml;Z=-2.12,P=0.034]。亚组分析显示,ST预后良好组、预后不良组与BP-ST组3组间年龄、BP病程、皮损分布及抗BP180 IgG抗体水平差异均有统计学意义(F=10.83,P<0.001;Z=17.24,P<0.001;χ^(2)=15.57,P=0.026;Z=6.29,P=0.043)。ST预后良好组年龄与预后不良组差异无统计学意义(校正后P=1.000),但均高于BP-ST组(校正后P值分别为0.001、0.007);ST预后不良组较预后良好组和BP-ST组BP病程短(校正后P=0.016、P<0.001),皮损累及四肢比例高(均P<0.05);ST预后不良组较BP-ST组抗BP180 IgG抗体水平高[226.2(163.6,285.8)U/ml比155.0(63.9,279.8)U/ml;校正后P=0.037]。BP+ST、BP-ST两组间及预后良好组、预后不良组与BP-ST组3组间性别构成、皮损形态、外周血嗜酸性粒细胞比例及计数、血清总IgE及抗BP230 IgG抗体水平差异均无统计学意义(均P>0.05)。相关性分析显示,BP+ST组BP病程与mRS评分负相关(r=-0.33,P=0.004),抗BP180 IgG抗体水平与mRS评分正相关(r=0.34,P=0.032)。结论伴与不伴脑卒中的BP患者在年龄、BP病程、皮损分布及抗BP180 IgG抗体水平方面存在差异,上述差异在脑卒中预后不良组BP患者更为明显。

Objective To investigate differences in clinical characteristics between bullous pemphigoid(BP)patients with stroke and those without,and their relationship with the prognosis of stroke.Methods A retrospective analysis was performed on medical records of 330 BP inpatients in the First Affiliated Hospital of Zhengzhou University from September 2012 to April 2020.These patients were divided into BP+stroke(ST)group and BP-ST group according to whether they were accompanied by stroke,and clinical manifestations and relevant laboratory examination results were compared between the two groups.According to the stroke outcome score assessed by modified Rankin Scale(mRS),patients in the BP+ST group were further divided into good-prognosis ST group(mRS≤2 points)and poor-prognosis ST group(mRS>2 points),and subgroup analysis was conducted.Correlations between measurement data(such as age,disease course and laboratory examination results)and mRS scores were analyzed.Results In the BP-ST group(256 cases),151 were males and 105 were females,and their age ranged from 19 to 92(66.8±13.6)years;in the BP+ST group(74 cases),45 were males and 29 were females,and their age ranged from 48 to 92(74.6±9.6)years;Compared with the BP-ST group,the BP+ST group showed older age(t=-5.57,P<0.001),shorter disease course of BP(Z=-3.07,P=0.002),and higher anti-BP180 IgG antibody levels(215.0[157.2,283.1]U/ml vs.155.0[63.9,279.8]U/ml;Z=-2.12,P=0.034).The distribution of skin lesions significantly differed between the two groups(χ^(2)=10.51,P=0.015),and the BP+ST group showed a significantly lower proportion of patients with generalized lesions(P<0.05),but a higher proportion of patients with lesions on the limbs(P<0.05).Subgroup analysis showed significant differences in the patients′age,BP course,lesion distribution and anti-BP180 IgG antibody levels among the good-prognosis ST group,poor-prognosis ST group and BP-ST group(F=10.83,P<0.001;Z=17.24,P<0.001;χ^(2)=15.57,P=0.026;Z=6.29,P=0.043,respectively).There was no significant difference in the age between the good-prognosis ST group and poor-prognosis ST group(adjusted P=1.000),but the patients were significantly older in the two above groups than in the BP-ST group(adjusted P=0.001,0.007,respectively);the poor-prognosis ST group showed significantly shorter BP course(adjusted P=0.016,<0.001,respectively)and a higher proportion of patients with lesions on the limbs(both P<0.05)compared with the good-prognosis ST group and BP-ST group,and significantly higher serum anti-BP180 IgG antibody levels compared with the BP-ST group(226.2[163.6,285.8]U/ml vs.155.0[63.9,279.8]U/ml;adjusted P=0.037).There were no significant differences in the gender distribution,lesional morphology,percentages and counts of peripheral blood eosinophils,serum total IgE levels,and anti-BP230 IgG antibody levels between the BP+ST group and BP-ST group(all P>0.05),or among the good-prognosis ST group,poor-prognosis ST group and BP-ST group(all P>0.05).Correlation analysis in the BP+ST group showed a significantly negative correlation between the BP course and mRS scores(r=-0.33,P=0.004),and a significantly positive correlation between the anti-BP180 IgG antibody levels and mRS scores(r=0.34,P=0.032).Conclusion There were differences in the patients′age,BP course,lesion distribution,and anti-BP180 IgG antibody levels between the BP patients with stroke and those without,and the differences were more obvious between the poor-prognosis ST group and BP-ST group.