本文關(guān)鍵詞： 大皰性類(lèi)天皰瘡 靜脈注射免疫球蛋白 有效性 安全性　出處：《山東大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:回顧分析系統(tǒng)應(yīng)用糖皮質(zhì)激素聯(lián)合靜脈注射免疫球蛋白治療大皰性類(lèi)天皰瘡的臨床應(yīng)用,評(píng)估該方案的有效性和安全性,為那些對(duì)傳統(tǒng)治療方案不敏感或不耐受的大皰性類(lèi)天皰瘡患者的治療提供臨床選擇。方法:共收集自2015年1月至2017年4月于山東大學(xué)齊魯醫(yī)院收入院治療的40例大皰性類(lèi)天皰瘡患者入組,所有患者均由臨床表現(xiàn)、組織病理和直接免疫熒光檢查確診為大皰性類(lèi)天皰瘡。根據(jù)日本大皰性類(lèi)天皰瘡疾病活動(dòng)評(píng)分(jBPAS)標(biāo)準(zhǔn),入組患者的jBPAS評(píng)分均≥4分。入院后根據(jù)患者病情需要并獲得知情同意后給予相應(yīng)的治療方案。根據(jù)住院期間使用的治療方案,分為單獨(dú)系統(tǒng)應(yīng)用糖皮質(zhì)激素治療組(GC組),系統(tǒng)應(yīng)用糖皮質(zhì)激素聯(lián)合靜脈注射免疫球蛋白治療組(GC+IVIG組)以及系統(tǒng)應(yīng)用糖皮質(zhì)激素聯(lián)合免疫抑制劑(環(huán)磷酰胺,CTX或甲氨蝶呤,MTX)治療組(GC+ISD組),入組的GC+IVIG組患者均對(duì)系統(tǒng)應(yīng)用糖皮質(zhì)激素和/或免疫抑制劑不敏感或不耐受。通過(guò)住院期間患者病情變化情況、用藥期間的不良反應(yīng)的記錄,將GC+IVIG組分別與GC組、GC+ISD組比較,以外周血嗜酸性粒細(xì)胞(EOS)計(jì)數(shù)、系統(tǒng)糖皮質(zhì)激素用量、住院天數(shù)、不良事件發(fā)生率、系統(tǒng)抗生素(米諾環(huán)素除外)的使用率等指標(biāo)評(píng)估GC+IVIG方案對(duì)傳統(tǒng)治療方案不敏感或不耐受患者的有效性和安全性。結(jié)果:共入組40例BP患者,其中GC組21例,GC+IVIG組12例,GC+ISD組7例。各組間性別、年齡、病程、jBPAS無(wú)明顯差異(P0.05)。1.嗜酸性粒細(xì)胞計(jì)數(shù)治療前,GC組、GC+IVIG組、GC +ISD組的嗜酸性粒細(xì)胞(EOS)計(jì)數(shù)分別為(1.288±1.488)*10^9/L,(1.354±0.874)*10^9/L,(0.295±0.651)*10^9/L,三組間EOS計(jì)數(shù)無(wú)明顯統(tǒng)計(jì)學(xué)差異(P=0.358)。治療后,三組EOS計(jì)數(shù)分別為(0.443±0.742)*10^9/L,(0.295±0.651)*10^9/L,(0.076±0.090)*10^9/L,三組間EOS計(jì)數(shù)仍無(wú)明顯統(tǒng)計(jì)學(xué)差異(P=0.131)。通過(guò)配對(duì)樣本秩和檢驗(yàn)發(fā)現(xiàn),GC+IVIG組、GC +ISD組在接受治療后EOS計(jì)數(shù)明顯降低,有統(tǒng)計(jì)學(xué)意義(P=0.025;P=0.017),但是兩組間下降幅度無(wú)顯著性差異(P=0.416),GC組接受治療后E0S計(jì)數(shù)無(wú)明顯下降(P=0.066)。2.系統(tǒng)糖皮質(zhì)激素使用劑量GC組、GC+IVIG組和GC +ISD組系統(tǒng)應(yīng)用糖皮質(zhì)激素劑量(潑尼松換算量)分別為(53.29±29.12)mg/d,(32.33±7.0)mg/d,(107.1±42.6)mg/d,三組間系統(tǒng)性糖皮質(zhì)激素用量存在顯著性差異(P=0.001)。與GC組、GC+ISD組相比,GC+IVIG組的系統(tǒng)應(yīng)用糖皮質(zhì)激素劑量明顯減少(P=0.022;P0.001,M-W檢驗(yàn))。另外,通過(guò)比較單位體重的系統(tǒng)應(yīng)用糖皮質(zhì)激素劑量發(fā)現(xiàn),GC組、GC+IVIG組和GC +ISD組系統(tǒng)應(yīng)用糖皮質(zhì)激素劑量分別為(1.03±0.69)mg/(kg ·d),(0.45±0.13)mg/(kg · d)和(1.56±0.52)mg/(kg · d),三組間系統(tǒng)性糖皮質(zhì)激素用量有顯著性差異(H=17.924,P0.001,Kruskal-Wallis檢驗(yàn))。兩兩對(duì)比后發(fā)現(xiàn),與GC組、GC+ISD組相比,GC+IVIG組患者系統(tǒng)應(yīng)用糖皮質(zhì)激素劑量顯著減少(調(diào)整P=0.014;調(diào)整P0.001),但GC組與GC+ISD組間糖皮質(zhì)激素用量無(wú)顯著性差別(調(diào)整P=0.221)。3.住院天數(shù)GC組、GC+IVIG組和GC +ISD組平均住院天數(shù)分別為(9.6±4.1)天,(8.1±3.7)天和(16.4±7.6)天,三組間住院天數(shù)存在統(tǒng)計(jì)學(xué)差異(P=0.011)。兩兩對(duì)比發(fā)現(xiàn),GC+IVIG組與GC組住院天數(shù)無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。與GC+ISD組相比,GC+IVIG組住院天數(shù)顯著減少(P=0.012,M-W檢驗(yàn);P=0.017,K-S檢驗(yàn))。4.不良反應(yīng)17例患者發(fā)生不良反應(yīng)事件,占所有入組患者的42.5%,主要與藥物的副作用、感染等因素有關(guān)。40例患者中與GC和/或ISD使用相關(guān)的不良反應(yīng)包括:血糖升高或原有糖尿病血糖控制不佳的7例,皮損糜爛面感染2例,馬拉色菌毛囊炎1例,肺部感染4例,肝功異常1例。與IVIG使用相關(guān)的不良反應(yīng)為頭痛1例,休息后好轉(zhuǎn),未行特殊處理。GC組中9例(9/21;42.9%)患者發(fā)生不良反應(yīng),GC+IVIG組3例(3/9;33.3%)患者發(fā)生不良反應(yīng),GC+ISD組5例(5/7;71.4%)患者發(fā)生不良反應(yīng)。與其他兩組相比,GC+IVIG組的不良反應(yīng)發(fā)生率無(wú)顯著性差異(P=0.704;P=0.315,Fisher精確檢驗(yàn)法)。5.抗生素的應(yīng)用GC組、GC+IVIG組和GC+ISD組系統(tǒng)抗生素使用率分別為23.8%、33.3%、0%。通過(guò)多個(gè)獨(dú)立樣本列聯(lián)表的卡方檢驗(yàn)發(fā)現(xiàn),三組間使用率無(wú)統(tǒng)計(jì)學(xué)差異(P=0.281,Fisher精確檢驗(yàn)法)。與其他兩組相比,GC+IVIG組的系統(tǒng)性抗生素使用率無(wú)明顯差異(P=0.421;P=0.128,Fisher精確檢驗(yàn)法)。結(jié)論:1.BP患者存在大劑量系統(tǒng)應(yīng)用糖皮質(zhì)激素和/或免疫抑制劑抵抗、不耐受現(xiàn)象時(shí),GC+IVIG是一種有效的選擇方案,能有效降低外周血EOS計(jì)數(shù),還可顯著減少系統(tǒng)應(yīng)用糖皮質(zhì)激素劑量,快速控制病情。2.GC+IVIG方案安全性高,不良反應(yīng)輕微且有自限性,嚴(yán)重不良反應(yīng)發(fā)生率低。
[Abstract]:Objective: To review the clinical application of systemic corticosteroids combined with intravenous immunoglobulin in the treatment of bullous pemphigoid, to evaluate the safety and effectiveness of the scheme, to provide clinical option for those of the traditional treatment is not sensitive or intolerant patients with bullous pemphigoid treatment. Methods: collected from January 2015 to April 2017 in the treatment of Qilu Hospital of Shandong University admitted 40 cases of bullous pemphigoid patients, all patients by clinical manifestations, histopathology and direct immunofluorescence examination confirmed the diagnosis of bullous pemphigoid. According to Japanese bullous pemphigoid disease activity score (jBPAS) standard, the patients in this group jBPAS scores were more than 4 points. After admission according to the patient's condition and need to obtain informed consent given after the corresponding treatment plan. According to the treatment plan of hospital use, should be divided into separate system Glucocorticoid treatment group (GC group), systemic corticosteroids combined with intravenous immunoglobulin treatment group (GC+IVIG group) and systemic corticosteroids combined with immunosuppressive agents (cyclophosphamide, methotrexate or CTX, MTX) treatment group (GC+ISD group), GC+IVIG group of patients were applied to the system of sugar corticosteroids and / or immunosuppressant insensitivity or intolerance. Through changes in patients during hospitalization, drug adverse reactions during the recording, the GC+IVIG group and GC group, GC+ISD group, peripheral blood eosinophil (EOS) count, duration of hospitalization, systemic corticosteroids dosage, incidence rate adverse events, systemic antibiotics (except minocycline) use rate and other indicators to assess the GC+IVIG of traditional treatment is not sensitive or intolerance of the effectiveness and safety of patients. Results: a total of 40 patients with BP, 2 in GC group 1渚，

本文編號(hào)：1499111