78例大疱性类天疱疮诊疗回顾及患者组织中CXCR5的表达与意义

发布时间：2019-03-22 14:19

【摘要】：1.78例大疱性类天疱疮诊疗回顾目的:大疱性类天疱疮是临床较常见的自身免疫性水疱病，发病机理复杂，其临床表现及实验室诊断有一定的特点，易合并其它内科疾病。我们通过对我院78例大疱性类天疱疮患者进行临床回顾性分析，以期进一步研究其临床特点、治疗方案等，为临床诊疗提供可靠的依据。方法:收集大连市皮肤病医院2007年1月-2012年1月期间诊治的78例住院患者，对其发病年龄、皮损特点、病情严重程度、组织病理、免疫病理、是否合并神经系统症状、治疗方案等列表登记，进行总结并分析。结果:本组资料共78例，其中男41例，占52.56%，女37例，占47.43%，平均发病年龄74.01±9.49岁，病情轻度28例，中度41例，重度9例，其中13例患者伴有粘膜损害，占16.6%，皮损严重程度与治疗时间呈正比，临床表现、病理检查与免疫荧光检查一致率为69.23%。其中15例合并神经系统疾病，占19.23%%，系统应用糖皮质激素是治疗的主要手段，也可联合应用免疫抑制剂治疗，对重症疗效欠佳或激素禁忌症者可应用丙种球蛋白冲击治疗。 2.CXCR5在类天疱疮皮损中的表达及临床意义目的:检测滤泡辅助性T细胞（Tfh）趋化因子受体-5（CXCR5）在大疱性类天疱疮患者皮损中的表达，分析和探讨CXCR5在大疱性类天疱疮发病机制中的作用。方法:应用免疫组织化学SP法，检测16例大疱性类天疱疮患者皮损及10例正常人皮肤组织中CXCR5表达。结果: CXCR5在正常皮肤组织表达于基底细胞层，主要表达于细胞质、细胞膜处，在大疱性类天疱疮皮损组织中表达于基底细胞层与棘细胞层，表达水平显著高于正常对照组织，有显著性差异（p0.5）。结论: CXCR5在大疱性类天疱疮患者皮损中表达较正常人皮肤组织增多，，提示Tfh(CXCR5)在大疱性类天疱疮的发病机制中起着极为重要的作用。总结论: 1.大疱性类天疱疮好发于老年人，性别对其发病无统计学差异。 2.组织病理、免疫荧光是确诊BP的主要方法。 3.可合并系统疾病以神经系统疾病为主。 4.糖皮质激素是控制疾病的主要治疗方法，可联合应用免疫抑制剂。 5.对重症疗效欠佳或有激素应用禁忌症者可选择丙种球蛋白冲击治疗。 6.CXCR5在正常皮肤组织表达于基底细胞层，主要表达于细胞质、细胞膜处，在大疱性类天疱疮皮损组织中表达于基底细胞层与棘细胞层，表达水平显著高于正常对照组织。 7.Tfh(CXCR5)在大疱性类天疱疮的发病机制中起着极为重要的作用。
[Abstract]:1. Review of diagnosis and treatment of 78 cases of bullous pemphigoid: bullous pemphigoid is a common autoimmune vesicular disease with complicated pathogenesis, and its clinical manifestations and laboratory diagnosis have some characteristics. It is easy to concomitant with other internal diseases. Through the retrospective analysis of 78 cases of bullous pemphigoid in our hospital, we hope to further study its clinical characteristics, treatment plan and so on, so as to provide reliable basis for clinical diagnosis and treatment. Methods: 78 inpatients were collected from January 2007 to January 2012 in Dalian Dermatological Hospital. Their age of onset, characteristics of skin lesions, severity of disease, histopathology, immunopathology and neurological symptoms were analyzed. A list of treatment regimens is registered, summarized and analyzed. Results: there were 78 cases, including 41 males (52.56%) and 37 females (47.43%). The average age of onset was 74.01 卤9.49 years old. 28 cases were mild, 41 cases were moderate and 9 cases were severe. Among them, 13 cases were accompanied by mucosal damage. It was 16.6%. The severity of skin lesions was proportional to the treatment time. The consistent rate between pathological examination and immunofluorescence examination was 69.23%. Among them, 15 cases (19.23%) were complicated with nervous system diseases. Systemic application of glucocorticoid was the main treatment method, and it could also be treated with immunosuppressive agents. Patients with severe adverse effects or hormonal contraindications can be treated with gamma globulin shock therapy. The expression of 2.CXCR5 in pemphigoid lesions and its clinical significance objective: to detect the expression of (Tfh) chemokine receptor-5 (CXCR5) on follicular helper T cells in patients with pemphigoid bullosa. To investigate the role of CXCR5 in the pathogenesis of bullous pemphigoid. Methods: immunohistochemical SP method was used to detect the expression of CXCR5 in the skin of 16 patients with bullous pemphigoid and 10 normal skin tissues. Results: CXCR5 was expressed in the basal cell layer, mainly in the cytoplasm and cell membrane, and in the basal cell layer and spinous cell layer in the pemphigoid bullous lesions, and the expression level was significantly higher than that in the normal control tissue. There was significant difference (p0.5). Conclusion: the expression of CXCR5 in the lesions of patients with bullous pemphigoid is higher than that in normal human skin, suggesting that Tfh (CXCR5) plays an important role in the pathogenesis of bullous pemphigoid. General conclusions: 1. Bullous pemphigoid is more common in the elderly, and there is no statistical difference in the incidence of bullous pemphigoid. 2. Histopathology and immunofluorescence are the main methods for the diagnosis of BP. 3. Diseases of the nervous system may be associated with diseases of the nervous system. 4. Glucocorticoid is the main therapeutic method to control diseases and can be used in combination with immunosuppressive agents. 5. Patients with severe adverse effects or contraindication of hormone use can be treated with gamma globulin shock therapy. 6.CXCR5 was expressed in the basal cell layer, mainly in the cytoplasm and cell membrane, and in the basal cell layer and spinous cell layer in the pemphigoid bullous lesions. The expression level was significantly higher than that in the normal control tissue. 7.Tfh (CXCR5) plays an important role in the pathogenesis of bullous pemphigoid.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R758.66

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