脑卒中患者体内BP抗体水平与大疱性类天疱疱患者认知功能研究

发布时间：2018-03-08 09:40

本文选题：大疱性类天疱疮　切入点：神经系统疾病　出处：《北京协和医学院》2015年博士论文　论文类型：学位论文

【摘要】：背景：大疱性类天疱疮(Bullous pemphigoid, BP)是一种多发于老年人群的自身免疫性皮肤病。国内外流行病学研究均提示BP常合并神经系统疾病(Neurological disorders, ND),其中较为常见的有痴呆和脑血管病。其机制尚不明确,有众多假说认为可能与分布在脑组织中的BP180/230神经亚型与皮肤中的相应皮肤亚型发生抗体交叉反应有关。第一部分：大疱性类天疱疮患者回顾性病历分析目的：明确我国BP患者合并ND的情况。方法：对2011年12月至2015年1月期间于协和医院皮肤科确诊BP的患者进行病历回顾和分析,将其划分为单纯BP组以及BP合并ND组,并对两组患者的性别、诊断BP年龄、其他合并症等临床信息进行组间比较。结果：63例BP患者中有14人至少合并一种ND(22.2%),其中9例为脑血管病(64.3%),3例为痴呆(21.4%)。结论：BP患者合并ND的比例较高,较常合并的ND为脑血管病和痴呆,且均为ND先发。第二部分：脑卒中患者血清中BP180/BP230抗体的检测目的：探讨脑卒中患者体内BP180/230自身抗体的存在情况。方法：收集2014年7月至2015年1月期间于协和医院神经科确诊脑卒中的患者及对照组受试者血清和病历资料利用ELISA方法检测其血清BP180抗体和BP230抗体水平,并比较相关信息的组间差异。结果：对89例脑卒中患者和101例对照组受试者进行BP180抗体检测发现,脑卒中组的BP180抗体阳性率显著高于对照组(12.4% vs 4.0%,p=0.032)；对34例脑卒中患者和34例对照组受试者的BP230抗体检测发现,脑卒中组患者血清中BP230抗体的阳性率高于对照组(14.7% vs 5.9%,p=0.231),但不具有显著性差异。结论：脑卒中组患者血清中BP抗体阳性率高于对照组,其中以BP180抗体的组间差异更为显著。第三部分：大疱性类天疱疮患者认知功能研究目的：探讨BP患者认知功能受损情况。方法：利用MMSE量表、Moca量表等常用初筛量表对BP患者组及对照组受试者进行认知功能水平的评估,并比较其组间差异。结果：对20例BP组患者及24例对照组受试者有进行MMSE量表评估,发现BP组患者的MMSE总分明显低于对照组受试者(p=0.039),认知功能受损率显著高于对照组(25% vs 4.2%,p=0.045)；对19例BP组患者及24例对照组受试者进行Moca量表评估,发现BP患者的Moca校正得分显著低于对照组(p=0.002),但认知功能受损率没有显著组间差异。结论：与对照组相比,BP患者组认知功能受损的情况更为严重。
[Abstract]:Background: Bullous pemphigoidis (BPP) is an autoimmune dermatosis in the elderly. Epidemiological studies at home and abroad suggest that BP is often associated with neurological disorders, NDN, among which dementia and brain disease are more common. Vascular disease. Its mechanism is not clear. There are many hypotheses that BP180/230 neural subtypes distributed in brain tissue may be involved in antibody cross reaction with corresponding skin subtypes. Part I: retrospective medical records analysis of bullous pemphigoid patients. Methods: from December 2011 to January 2015, the BP patients who were diagnosed by the Department of Dermatology in Union Hospital were reviewed and analyzed. The patients were divided into simple BP group and BP combined with ND group. Results 14 out of 63 cases of BP patients were associated with at least one type of NDN 22.2, of which 9 cases were associated with cerebrovascular disease 64.3%, 3 cases with dementia and 21.40.Conclusion the proportion of patients with head BP with ND is higher. The more commonly associated ND is cerebrovascular disease and dementia, The second part: detection of BP180/BP230 antibody in the serum of stroke patients. Objective: to investigate the existence of autoantibodies against BP180/230 in stroke patients. Methods: from July 2014 to January 2015, we collected the autoantibodies against BP180/230 from July 2014 to January 2015 in Concorde Hospital. The serum and medical records of patients with stroke diagnosed by neurology and control group were measured by ELISA method to detect the levels of BP180 antibody and BP230 antibody. Results: BP180 antibodies were detected in 89 stroke patients and 101 control subjects. The positive rate of BP180 antibody in stroke group was significantly higher than that in control group (12.4% vs 4.0% vs 0.032%). The positive rate of serum BP230 antibody in stroke group was higher than that in control group (14.7% vs 5.9% vs 0.231%), but there was no significant difference. Conclusion: the positive rate of BP antibody in stroke group is higher than that in control group. The third part: the cognitive function of patients with bullous pemphigoid was studied. Objective: to study the cognitive impairment of BP patients. Methods: to use the MMSE scale and Moca scale to evaluate the cognitive function of patients with pemphigoid bullous. Methods: to study the cognitive function of patients with bullous pemphigoid. The cognitive function of patients with BP and control group was evaluated. Results: 20 patients in BP group and 24 subjects in control group were assessed with MMSE scale. It was found that the total score of MMSE in the BP group was significantly lower than that in the control group (0.039%), and the rate of cognitive impairment was significantly higher than that in the control group (25%) vs 4.2% (0.045%), 19 patients in the BP group and 24 subjects in the control group were assessed with Moca scale. It was found that the scores of Moca correction in BP patients were significantly lower than those in the control group, but there was no significant difference in the rate of cognitive impairment between the two groups. Conclusion: compared with the control group, the cognitive impairment in the BP group is more serious.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R743.3;R758.66

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