本文選題：大皰性類天皰瘡 + 抗BP180抗體　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:大皰性類天皰瘡(BP)是嚴(yán)重的自體免疫性大皰性皮膚病,好發(fā)于老年人,皮損為緊張性水皰大皰,可有破潰、糜爛,常伴有劇烈瘙癢,嚴(yán)重的影響患者的生存質(zhì)量,甚至危及生命。盡管治療方法不斷改進(jìn),但是BP的年病死率仍然較高,文獻(xiàn)報(bào)道為13%~38%。隨著社會的老齡化,患者發(fā)病呈快速增長趨勢,尋求一種能被大部分患者接受的副作用小的治療方法迫在眉睫。血漿置換可對患者炎癥介質(zhì)及致病性抗體進(jìn)行有效清除,同時可減少糖皮質(zhì)激素用量,降低糖皮質(zhì)激素的副反應(yīng),對治療重度的大皰性類天皰瘡具有很好的療效,但血漿置換價格昂貴,增加了患者的負(fù)擔(dān),經(jīng)濟(jì)受限,所以我科采用間斷血漿輸注治療部分大皰性類天皰瘡患者,取得了一定的成效。本研究分析我科近六年來收治的大皰性類天皰瘡患者的臨床資料,總結(jié)其臨床特征、組織病理檢查等,通過對比不同治療方法治療前后大皰性類天皰瘡患者的抗體滴度,抗體亞型及相關(guān)細(xì)胞因子水平的變化,分析相關(guān)細(xì)胞因子與疾病的發(fā)生關(guān)系,評價血漿療法(包括血漿置換及血漿輸注)對大皰性類天皰瘡的治療效果,同時對其治療機(jī)制進(jìn)行探討,為臨床治療提供新思路。方法:分析2009年12月至2015年12月期間我院皮膚科收治的111例大皰性類天皰瘡患者臨床資料;采用ELISA法檢測經(jīng)不同治療方法包括血漿療法和單純激素治療各20名大皰性類天皰瘡患者治療前后與同期來我院體檢的20名健康者血清中抗BP180抗體滴度,抗BP180抗體亞型Ig G1、Ig G4含量,及相關(guān)細(xì)胞因子IL-5、IL-6、IL-8、IL-10、IL-13、IL-18、TNF-α、IFN-γ的表達(dá)情況。所有統(tǒng)計(jì)學(xué)處理采用SPSS21.0軟件,計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差((x|-)±s)表示,計(jì)數(shù)資料采用(n,%)表示。結(jié)果:1臨床結(jié)果:1)一般情況:111例患者中,男性為62例(55.86%),女性為49例(44.14%)。年齡范圍6~94歲,均值為(68.32±16.43)歲。70歲以上的發(fā)病患者占比為63.97%。從尼氏征來看,111例患者中,陰性為98例,可疑陽性為8例,陽性為5例。111例患者中,54例患者合并心血管疾病,其中9例為冠心病,45例為高血壓;22例患者合并腦血管疾病;16例患者合并糖尿病。組織病理檢查:108例患者為表皮下大皰,陽性率98.20%。2)治療效果:經(jīng)治療后,血漿療法組有效率為92.31%,單純激素治療組為78.94%。3)不良反應(yīng):血漿療法組患者未出現(xiàn)不良反應(yīng);單純激素治療組出現(xiàn)7例不良反應(yīng)(1例肝功能異常、3例血糖升高、3例口腔真菌感染)。2實(shí)驗(yàn)結(jié)果:1)抗BP180抗體滴度:大皰性類天皰瘡患者經(jīng)過不同治療,治療后較治療前抗BP180抗體滴度明顯下降(P0.01)。2)抗體亞型:大皰性類天皰瘡患者中存在Ig G1、Ig G4抗體亞型,治療前各Ig G亞型陽性率差異無明顯統(tǒng)計(jì)學(xué)差異,陽性率依次為Ig G1(85%)Ig G4(75%);治療后各Ig G亞型陽性率有所下降,但無明顯統(tǒng)計(jì)學(xué)差異,各亞型間無統(tǒng)計(jì)學(xué)差異,陽性率依次為Ig G1(75%)Ig G4(55%)。3)相關(guān)細(xì)胞因子IL-5、IL-6、IL-8、IL-10、IL-13、IL-18、TNF-α、IFN-γ水平:大皰性類天皰瘡患者IL-5、IL-10、IL-13、IL-18、IFN-γ水平明顯高于正常對照組(P0.05);大皰性類天皰瘡患者IL-6、IL-8、TNF-α與正常對照組對比無明顯差異;經(jīng)過不同治療,治療后較治療前IL-5、IL-10、IL-13、IL-18、IFN-γ值明顯下降(P0.05);血漿療法組各指標(biāo)較單純激素治療組治療后下降幅度進(jìn)一步升高(P0.05)。結(jié)論:1大皰性類天皰瘡患者多見于70歲以上老年人,大皰性類天皰瘡患者主要合并高血壓病、腦血管疾病及糖尿病。2血漿療法治療大皰性類天皰瘡有效,副作用小。3大皰性類天皰瘡患者血清中存在Ig G1、Ig G4抗體亞型,治療前各Ig G1亞型陽性率高于Ig G4亞型,治療后兩者陽性率均下降,提示與疾病的活動度有關(guān)。4 IL-5、IL-10、IL-13、IL-18、IFN-γ參與了大皰性類天皰瘡的發(fā)病,反應(yīng)患者的治療效果;血漿療法通過減少患者體內(nèi)的這些相關(guān)性細(xì)胞因子,對大皰性類天皰瘡患者有著顯著的療效。
[Abstract]:Objective: bullous pemphigoid (BP) is a serious autoimmune bullous dermatosis, which is well distributed in the elderly. The skin lesions are stressful bullous bullous bullous, which can have rupture, erosion and severe pruritus, which seriously affect the quality of life and even life. Although the treatment method is constantly improved, the mortality rate of BP is still higher, literature is still high, literature It is reported that with the aging of the society, 13%~38%. has a rapid growth trend, and it is imminent to seek a small side effect that can be accepted by most patients. Plasma exchange can effectively remove the inflammatory mediators and pathogenic antibodies, reduce the dose of glucocorticoids and reduce the side reaction of glucocorticoids. It is good for the treatment of severe bullous pemphigoid, but the price of plasma exchange is expensive, the burden of the patient is increased, the economy is limited, so our department uses intermittent plasma infusion in the treatment of partial bullous pemphigoid patients and has achieved certain results. This study analyzed the bullous pemphigoid patients in our department for nearly six years. The clinical data, the clinical features, the histopathological examination, and the changes in the antibody titer, the antibody subtype and the related cytokine levels of the bullous pemphigoid patients before and after the treatment were compared, and the relationship between the related cytokines and the disease was analyzed, and the plasma therapy (including plasma exchange and plasma infusion) was evaluated. The therapeutic effect of bullous pemphigoid and its treatment mechanism were discussed in order to provide new ideas for clinical treatment. Methods: the clinical data of 111 patients with bullous pemphigoid treated in the Department of Dermatology of our hospital from December 2009 to December 2015 were analyzed, and the ELISA method was used to detect the different treatment methods including plasma therapy and simple hormone. The serum anti BP180 antibody titer, the anti BP180 antibody subtype Ig G1, the Ig G4 content, and the related cytokines IL-5, IL-6, IL-8, IL-10, IL-13, IL-18, alpha, and gamma were observed before and after the treatment of 20 bullous pemphigoid patients and 20 healthy persons who came to our hospital during the same period. Using mean number + standard deviation ((x|-) + s), the count data were expressed by (n,%). Results: 1 clinical results: 1) general situation: among 111 patients, 62 cases (55.86%) and 49 women (44.14%). The average age range was 6~94 years old, the average value was (68.32 + 16.43) years older than nil's sign, and 111 patients were negative. In 98 cases, 8 cases were suspected positive, 5 cases of.111 positive, 54 patients with cardiovascular disease, including 9 cases of coronary heart disease, 45 cases of hypertension, 22 patients with cerebrovascular disease, 16 patients with diabetes. Histopathological examination: 108 patients were the epidermis blisters, positive rate 98.20%.2) treatment effect: after treatment, plasma therapy The efficacy of the group was 92.31%, the only hormone treatment group was 78.94%.3) adverse reaction: the patients in the plasma therapy group had no adverse reactions, and the simple hormone therapy group had 7 adverse reactions (1 cases of liver dysfunction, 3 cases of blood glucose increase, 3 cases of oral fungal infection).2 test results: 1) the titer of anti BP180 antibody: the patients with bullous pemphigoid were treated in different treatments, After treatment, the anti BP180 antibody titer significantly decreased (P0.01).2) antibody subtype: there were Ig G1 and Ig G4 subtypes in pemphigoid patients with bullous pemphigoid, and there was no significant difference in the positive rate of Ig G subtypes before treatment, and the positive rate was Ig G1 (85%) Ig (75%). The positive rates were Ig G1 (75%) Ig G4 (55%).3) related cytokine IL-5, IL-6, IL-8, IL-10, IL-13, IL-18, TNF- alpha level: bullous pemphigoid level was significantly higher than that of the normal control group; There was no significant difference in the contrast group. After treatment, the value of IL-5, IL-10, IL-13, IL-18, IFN- gamma decreased significantly after treatment (P0.05), and the decrease of each index in the plasma therapy group was higher than that in the simple hormone treatment group (P0.05). Conclusion: 1 pemphigoid patients were mostly seen in older people over 70 years old and bullous type. The patients with pemphigus mainly include hypertension, cerebrovascular disease and diabetes.2 plasma therapy for bullous pemphigoid, and there are Ig G1, Ig G4 subtypes in the sera of patients with small.3 bullous pemphigoid, and the positive rate of Ig G1 subtypes before treatment is higher than that of Ig G4 subtype, and the positive rates of both patients are decreased after treatment, suggesting the survival of the disease. The dynamics of.4 IL-5, IL-10, IL-13, IL-18, and IFN- gamma are involved in the pathogenesis of bullous pemphigoid and response to the treatment effect. Plasma therapy has a significant effect on bullous pemphigoid patients by reducing these related cytokines in the patient's body.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R758.66

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 徐牧遲;潘萌;朱海琴;李衛(wèi)平;葉亞芬;徐靜;鄭捷;;外用強(qiáng)效糖皮質(zhì)激素聯(lián)合中、低劑量口服糖皮質(zhì)激素治療大皰性類天皰瘡的療效與安全性評價[J];上海醫(yī)藥;2016年09期

2 尹頌超;張?jiān)魄?楊素蓮;李歡;羅敏琪;;老年大皰性類天皰瘡的臨床特點(diǎn)及治療分析[J];臨床醫(yī)學(xué)工程;2016年03期

3 陳喜雪;丁治云;王明悅;彭洋;朱學(xué)駿;;米諾環(huán)素和煙酰胺聯(lián)合小劑量糖皮質(zhì)激素治療62例大皰性類天皰瘡[J];臨床皮膚科雜志;2015年12期

4 蘇日古嘎;王曉彥;韓建文;;內(nèi)蒙古漢族大皰性類天皰瘡與HLA-DRB1和DQB1基因相關(guān)性分析[J];中國皮膚性病學(xué)雜志;2015年12期

5 姚磊;曾磊;王培光;;大皰性類天皰瘡免疫學(xué)發(fā)病機(jī)制研究進(jìn)展[J];中國麻風(fēng)皮膚病雜志;2015年04期

6 丁治云;吳衛(wèi)志;王明悅;陳喜雪;朱學(xué)駿;;米諾環(huán)素聯(lián)合煙酰胺治療121例大皰性類天皰瘡[J];臨床皮膚科雜志;2014年11期

7 王明悅;王佩茹;彭洋;陳喜雪;朱學(xué)駿;;BP180抗原與自身免疫性大皰性皮膚病的研究進(jìn)展[J];免疫學(xué)雜志;2014年10期

8 白雪;馬杰;宋丹;鄭可;夏京華;李雪梅;;血漿置換治療3例尋常型天皰瘡的治療體會[J];中國血液凈化;2014年05期

9 徐曉巍;王燕華;;大皰性類天皰瘡與細(xì)胞因子關(guān)系的研究進(jìn)展[J];醫(yī)學(xué)綜述;2012年20期

10 杜明;張秀娟;張宏剛;;血漿置換療法治療糖皮質(zhì)激素抵抗大皰性類天皰瘡療效分析[J];河北醫(yī)科大學(xué)學(xué)報(bào);2012年06期

相關(guān)碩士學(xué)位論文 前2條

1 張麗;IgG相關(guān)性皰病免疫球蛋白亞型分布的研究[D];福建醫(yī)科大學(xué);2015年

2 吳遠(yuǎn)慧;白介素17、白介素22在大皰性類天皰瘡患者皮損及血清中的表達(dá)與意義[D];河北醫(yī)科大學(xué);2013年

，

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