【作者】 高鹏；

【导师】 孙青；

【作者基本信息】 山东大学 ， 皮肤病与性病学， 2007， 硕士

【摘要】 目的分析轻、中、重度大疱性类天疱疮患者的临床表现及相应的治疗方法，以探求治疗BP的最佳方法。方法回顾性收集了山东大学齐鲁医院皮肤科病房在1996年1月～2006年10月期间收治的56例BP住院患者的病历，对患者的发病年龄、病程、皮损特点、病情严重程度、组织病理及免疫病理、血清IgE值、合并症、误诊情况、住院时间及治疗方案等项目列表登记。结果本组资料共56例患者，其中男31例(占55.345％)，女25例(占44.64％)。年龄20岁—95岁，平均发病年龄63.53±18.93岁，其中20—40岁6例(占10.72％)，41—60岁11例(占19.64％)，＞60岁39例(占69.64％)。年龄≤60岁的患者中，轻度患者1例，中度患者7例，重度患者9例。皮损具有多形性。21.43％的患者有粘膜损害。随病情加重，粘膜受累比率增加。56例患者均行病理检查；23例行免疫病理检查，免疫病理阳性率为91.3％。重度组患者有8例(8／17)出现IgE升高，中度组有3例(3／32)IgE升高，轻度组未发现IgE升高患者。糖皮质激素系统、局部应用及糖皮质激素联合免疫抑制剂、静脉输注新鲜血浆等是治疗大疱性类天疱疮的主要手段。轻、中、重组应用糖皮质激素初始剂量和最大剂量值差异均有显著的统计学意义。结论1．BP多发生于老年人，但年轻患者皮损比老年患者更严重。2．组织病理和免疫荧光检查是确诊的主要依据。3．随BP病情加重，糖皮质激素初始剂量和控制病情所需最大剂量增加明显。4．随病情加重，粘膜受累比率增加。5．应用免疫抑制剂应强调个体化。6．对于常规治疗无效，且对大剂量糖皮质激素无禁忌证的病例，可以应用糖皮质激素冲击疗法。7．局部外用强效糖皮质激素治疗BP是安全和有效的。8．ⅣIG是治疗BP安全、有效的药物，特别是对于常规治疗无效的中、重症患者。更多还原

【Abstract】 OBJECTIVE To analyze the clinical features and therapy of patients with various degree of bullous pemphigoid,the objective of the thesis is to improve the therapy of BP.METHODS Clinical data of 56 cases of BP from January 1996 to October 2006 in the Department of Dermatology,Qilu Hospital,Shandong University were retrospectively analyzed.It is illustrated in detail about the age of onset,pathogenesis, patient condition,IgE,histopathology,immunofluorescence,complication,misdiagnosis and therapy.RESULTS 56 patients,31 males and 25 females,were enrolled ,whose average age was 63.53±18.93years old. 56 patients have 6 patients of 20-40 years old(10.72% )and 11 patients of 41-60 years old(19.64%)and 39 patients of more than 60 years old(69.64%). In the patients of less than 60 years old ,there are 1 light patients,8 midrange patients , 9 severe patients. The eruption of BP have pleomorphism. Mucosal lesions occurred in 21.43% of patients. The more patient’s condition was severe,the higher ratio of mucosae involved was. All patients were examined by histopathology.Immunopathogenesis was positive in 91.3% patients.Serum IgE was higher than normal in 8/17 severe patients,3/32 midrange patients and in 0/7 light patients.The patients were mainly treated with glucocorticoid or the combination of glucocorticoid with immunosuppressive agents ,blood plasma . The initial doses and maximum glucocorticoid doses needed to control lesions were different noticeably for different degree lesions . CONCLUSION 1. BP primarily affects old people. BP eruption of young people was more severe than that of old people .2. The diagnosis of BP is based on histopathology and immunofluorescence.3. The initial doses and maximum glucocorticoid doses needed to control lesions were increased noticeably ,following BP pathogenetic condition aggravating.4. The more patient’s condition was severe.the higher ratio of mucosae involved was.5. Immunosuppressive drugs should be used individually according to patient’s condition.6. The patients who could not be controlled by routine treatment and had no contraindication to large dose glucocorticoid. could treat with glucocorticoid stosstherapy.7. Local glucocorticoid treatment was safe and effective to BP.8. IVIG was safety and effective to treat BP.更多还原