大疱性类天疱疮合并神经系统疾病的回顾性分析

发布时间：2018-03-09 22:45

本文选题：大疱性类天疱疮　切入点：脑血管疾病　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景大疱性类天疱疮(Bullous Pemphigoid,BP)是一种自身免疫性皮肤病,大多发生于老年人。流行病学资料表明BP与神经系统疾病(Neurological diseases,ND)显著相关,报道最多的为痴呆、脑血管病、帕金森病、多发性硬化、肌萎缩侧索硬化症等,但合并ND的BP在临床特点和实验室检查等方面与未合并者的差异罕有文献报道。研究目的回顾性分析合并神经系统疾病的BP患者与未合并者在临床特点和实验室检查等方面的差异,为伴有神经系统疾病的BP的诊断及治疗提供参考。研究方法收集2010年1月-2016年6月于山东大学齐鲁医院皮肤科首次确诊并住院治疗的BP患者,按是否伴有神经系统疾病,分为BP+ND组及BP-ND组,分析两组BP患者在临床特点和实验室检查等方面的差异。采用SPSS 22.0软件进行统计学分析。P0.05为差异有统计学意义。结果本研究BP-ND组纳入34例患者,BP+ND组纳入17例患者,合并神经系统疾病的BP患者所占比例为33.3%。1.性别:共纳入男性患者24例,女性患者27例,BP-ND组中,男15例,女19例;BP+ND组中,男9例,女8例,两组间性别组成差异无统计学意义(P=0.056)。2.发病年龄:BP-ND组平均发病年龄70.1岁(95%CI 65.8-74.4岁),年龄范围36-87岁,中位发病年龄为74岁;BP+ND组平均发病年龄76.1岁(95%CI 72.0-80.0岁),年龄范围60-90岁,中位发病年龄77岁,但两组间发病年龄差异无统计学意义(P=0.211)。3.合并神经系统疾病:在确诊的伴有神经系统疾病的22例BP患者(包括BP+ND组的17例患者及因符合排除标准而未纳入BP+ND组的5例确诊的伴有神经系统疾病的BP患者)中,合并最多的神经系统疾病为脑血管病,其中脑梗死12例,脑出血2例;3例帕金森患者,其中1例伴有脑梗死;2例痴呆患者,其中1例为阿尔茨海默症,1例为混合性痴呆合并脑梗死;2例脑萎缩患者;1例腰椎间盘突出及椎管狭窄患者。4.ND至BP发病的时间:ND至BP发病平均时间为8.1年(95%CI4.2-12.0年),范围0-20年,中位时间为7.0年,1例患者于BP确诊后数天内发生脑梗死。5.明确诊断前病程:BP-ND组平均明确诊断前病程为4.7月(95%CI 2.3-7.1月),BP+ND组诊断前病程为3.3月(95%CI 0.1-6.4月),两组间诊断前病程差异无统计学意义(P=0.131)。6.嗜酸性粒细胞水平:BP-ND组及BP+ND组嗜酸性粒细胞计数平均值分别为 0.77*109/L(95%CI 0.28-1.27*109/L)及 0.70*109/L(95%CI 0.31-1.09*109/L),BP-ND组及BP+ND组嗜酸性粒细胞百分比平均数分别为6.31%(95%Cl 3.28-9.33%)及 7.45%(95%CI 3.70-11.21%),BP-ND 组及 BP+ND 组嗜酸性粒细胞计数和/或百分比升高的患者所占比例分别为29.4%和52.9%,以上差异均无统计学意义(P0.05)。7.血清总 IgE 水平:BP-ND 组总 IgE 平均值为 1952 IU/ml(95%CI 742-3616 IU/ml),BP+ND 组总 IgE 平均值为 4232 IU/ml(95%CI 1741-6721 IU/ml),两组间差异无统计学意义(P=0.061)。8.糖皮质激素用量:将两组患者住院期间所系统应用糖皮质激素均换算为泼尼松的用量,BP-ND组控制病情的最大激素剂量平均值为69.3mg/d(95%Cl 56.5-82.1mg/d),高于 BP+ND 组的 54.6 mg/d(95%CI 43.8-65.3mg/d);BP-ND组以控制病情的最大糖皮质激素剂治疗时间的平均值为9.1天(95%CI 7.3-10.9天),BP-ND组为8.5天(95%CI6.2-10.7天);BP-ND组患者控制病情所需的糖皮质激素总量平均值为710.3mg(95%CI 533.9-886.7mg),高于BP+ND组的464.Omg(95%CI 330.9-597.2mg),但上述差异均无统计学意义(P0.05)。排除免疫抑制剂对糖皮质激素用量的影响后,上述指标差异仍无统计学意义(P0.05)。结论1.BP患者合并最多的神经系统疾病为脑血管病,ND至BP发病平均时间为8.1 年;2.无论是否合并神经系统疾病,BP患者的明确诊断前病程、血清总IgE水平、嗜酸性粒细胞水平及初始治疗控制病情所需的系统糖皮质激素用量均无明显差别。
[Abstract]:The research background of bullous pemphigoid (Bullous Pemphigoid BP) is an autoimmune skin disease, mostly occurs in the elderly. Epidemiological data indicate that BP and nervous system diseases (Neurological diseases, ND) was significantly related to the most frequently reported for dementia, cerebrovascular disease, Parkinson's disease, multiple sclerosis, muscular amyotrophic lateral sclerosis, but the difference has been rarely reported with ND BP in terms of clinical characteristics and laboratory examination and without diabetes mellitus. The purpose of the study is to retrospectively analyze the BP patients with nervous system disease and not combined in clinical features and laboratory examination of the differences, and provide reference for diagnosis and treatment with nervous system diseases BP. Methods from January 2010 -2016 year in June in the Department of Dermatology of Qilu Hospital of Shandong University were first diagnosed and hospitalized BP patients, according to whether patients with nervous system disease, divided into BP+N D group and BP-ND group. The analysis of differences in clinical features and laboratory examinations of the two groups of patients with BP were analyzed..P0.05 had significant difference with SPSS 22 software. Results in the BP-ND group, 34 patients were included in this study, the BP+ND group included 17 patients, BP patients with nervous system diseases accounted for 33.3%.1. gender: a total of 24 male patients, 27 female patients in the BP-ND group, male 15 cases, female 19 cases; group BP+ND, male 9 cases, female 8 cases, gender composition between the two groups showed no significant difference (P=0.056):.2. age: group BP-ND (the average age of 70.1 years 95%CI 65.8-74.4 years old), age range 36-87 years old, the median age was 74 years; in group BP+ND, the average age of 76.1 years (95%CI 72.0-80.0 years), the age range of 60-90 years, median age was 77 years old, but the difference of age between the two groups had no statistical significance (P=0.211).3. with nervous system Disease: in 22 BP patients with nervous system disease (including 17 cases of BP+ND patients and the exclusion criteria are not included in the BP patients with 5 cases of group BP+ND with nervous system diseases, nervous system diseases) most with cerebrovascular disease, including 12 cases of cerebral infarction, 2 cases of cerebral hemorrhage; 3 cases of Parkinson's patients, including 1 patients with cerebral infarction; 2 cases of dementia, including 1 cases of Alzheimer's disease, 1 cases of mixed dementia complicated with cerebral infarction; 2 cases of patients with brain atrophy; 1 cases of lumbar disc herniation and spinal stenosis in patients with.4.ND to BP onset time: the average time of onset of ND to BP for 8.1 years (95%CI4.2-12.0 years), 0-20 years, the median time was 7 years, 1 patients in a few days after the diagnosis of BP in cerebral infarction diagnosis was.5.: BP-ND group before the diagnosis of average duration of disease was 4.7 months (95%CI 2.3-7.1 months), BP+ND group before the diagnosis of disease were 3.3 Months (95%CI 0.1-6.4 months), between the two groups before diagnosis was no statistically significant difference (P=0.131).6. eosinophil levels: BP-ND group and BP+ND group eosinophil count average values were 0.77*109/L (95%CI 0.28-1.27*109/L) and 0.70*109/L (95%CI 0.31-1.09*109/L), BP-ND group and BP+ND group. The average percentage of eosinophils the number was 6.31% (95%Cl 3.28-9.33%) and 7.45% (95%CI 3.70-11.21%), BP-ND group and BP+ND group, eosinophil count and / or increase the percentage of the proportion of patients were 29.4% and 52.9%, the differences were not statistically significant (P0.05) total IgE serum.7. levels: BP-ND group total IgE average value is 1952 IU/ml (95%CI IU/ml 742-3616), BP+ND group total IgE average value is 4232 IU/ml (95%CI 1741-6721 IU/ml), there was no significant difference between the two groups (P=0.061).8. glucocorticoid dosage: two groups of patients in hospital During the application of glucocorticoid are converted to the dosage of prednisone, the maximum hormone dose BP-ND group to control the disease with an average of 69.3mg/d (95%Cl 56.5-82.1mg/d), higher than 54.6 in group BP+ND (95%CI mg/d 43.8-65.3mg/d); the average value of the largest glucocorticoid agent BP-ND group to control the disease treatment time was 9.1 days (95%CI 7.3-10.9 day), BP-ND group was 8.5 days (95%CI6.2-10.7 days); glucocorticoid total BP-ND patients to control the disease required an average of 710.3mg (95%CI 533.9-886.7mg), 464.Omg (95%CI higher than BP+ND group, 330.9-597.2mg), but there was no statistically significant difference (P0.05). The effect of exclusion of immunosuppressive agents on glucocorticoid the amount, the differences are not statistically significant (P0.05). Conclusion the 1.BP patients with the most nervous system diseases were cerebrovascular disease, ND to BP onset time for an average of 8.1 years; 2. no matter whether In combination with neurological diseases, there was no significant difference in the total course of diagnosis, total serum IgE level, eosinophil level and the dosage of systemic glucocorticoid used in the initial treatment of BP patients.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R758.66;R741

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