本文選題：大皰性類天皰瘡　切入點(diǎn)：神經(jīng)系統(tǒng)疾病　出處：《北京協(xié)和醫(yī)學(xué)院》2015年博士論文　論文類型：學(xué)位論文

【摘要】：背景：大皰性類天皰瘡(Bullous pemphigoid, BP)是一種多發(fā)于老年人群的自身免疫性皮膚病。國內(nèi)外流行病學(xué)研究均提示BP常合并神經(jīng)系統(tǒng)疾病(Neurological disorders, ND),其中較為常見的有癡呆和腦血管病。其機(jī)制尚不明確,有眾多假說認(rèn)為可能與分布在腦組織中的BP180/230神經(jīng)亞型與皮膚中的相應(yīng)皮膚亞型發(fā)生抗體交叉反應(yīng)有關(guān)。第一部分：大皰性類天皰瘡患者回顧性病歷分析目的：明確我國BP患者合并ND的情況。方法：對(duì)2011年12月至2015年1月期間于協(xié)和醫(yī)院皮膚科確診BP的患者進(jìn)行病歷回顧和分析,將其劃分為單純BP組以及BP合并ND組,并對(duì)兩組患者的性別、診斷BP年齡、其他合并癥等臨床信息進(jìn)行組間比較。結(jié)果：63例BP患者中有14人至少合并一種ND(22.2%),其中9例為腦血管病(64.3%),3例為癡呆(21.4%)。結(jié)論：BP患者合并ND的比例較高,較常合并的ND為腦血管病和癡呆,且均為ND先發(fā)。第二部分：腦卒中患者血清中BP180/BP230抗體的檢測目的：探討腦卒中患者體內(nèi)BP180/230自身抗體的存在情況。方法：收集2014年7月至2015年1月期間于協(xié)和醫(yī)院神經(jīng)科確診腦卒中的患者及對(duì)照組受試者血清和病歷資料利用ELISA方法檢測其血清BP180抗體和BP230抗體水平,并比較相關(guān)信息的組間差異。結(jié)果：對(duì)89例腦卒中患者和101例對(duì)照組受試者進(jìn)行BP180抗體檢測發(fā)現(xiàn),腦卒中組的BP180抗體陽性率顯著高于對(duì)照組(12.4% vs 4.0%,p=0.032)；對(duì)34例腦卒中患者和34例對(duì)照組受試者的BP230抗體檢測發(fā)現(xiàn),腦卒中組患者血清中BP230抗體的陽性率高于對(duì)照組(14.7% vs 5.9%,p=0.231),但不具有顯著性差異。結(jié)論：腦卒中組患者血清中BP抗體陽性率高于對(duì)照組,其中以BP180抗體的組間差異更為顯著。第三部分：大皰性類天皰瘡患者認(rèn)知功能研究目的：探討B(tài)P患者認(rèn)知功能受損情況。方法：利用MMSE量表、Moca量表等常用初篩量表對(duì)BP患者組及對(duì)照組受試者進(jìn)行認(rèn)知功能水平的評(píng)估,并比較其組間差異。結(jié)果：對(duì)20例BP組患者及24例對(duì)照組受試者有進(jìn)行MMSE量表評(píng)估,發(fā)現(xiàn)BP組患者的MMSE總分明顯低于對(duì)照組受試者(p=0.039),認(rèn)知功能受損率顯著高于對(duì)照組(25% vs 4.2%,p=0.045)；對(duì)19例BP組患者及24例對(duì)照組受試者進(jìn)行Moca量表評(píng)估,發(fā)現(xiàn)BP患者的Moca校正得分顯著低于對(duì)照組(p=0.002),但認(rèn)知功能受損率沒有顯著組間差異。結(jié)論：與對(duì)照組相比,BP患者組認(rèn)知功能受損的情況更為嚴(yán)重。
[Abstract]:Background: Bullous pemphigoidis (BPP) is an autoimmune dermatosis in the elderly. Epidemiological studies at home and abroad suggest that BP is often associated with neurological disorders, NDN, among which dementia and brain disease are more common. Vascular disease. Its mechanism is not clear. There are many hypotheses that BP180/230 neural subtypes distributed in brain tissue may be involved in antibody cross reaction with corresponding skin subtypes. Part I: retrospective medical records analysis of bullous pemphigoid patients. Methods: from December 2011 to January 2015, the BP patients who were diagnosed by the Department of Dermatology in Union Hospital were reviewed and analyzed. The patients were divided into simple BP group and BP combined with ND group. Results 14 out of 63 cases of BP patients were associated with at least one type of NDN 22.2, of which 9 cases were associated with cerebrovascular disease 64.3%, 3 cases with dementia and 21.40.Conclusion the proportion of patients with head BP with ND is higher. The more commonly associated ND is cerebrovascular disease and dementia, The second part: detection of BP180/BP230 antibody in the serum of stroke patients. Objective: to investigate the existence of autoantibodies against BP180/230 in stroke patients. Methods: from July 2014 to January 2015, we collected the autoantibodies against BP180/230 from July 2014 to January 2015 in Concorde Hospital. The serum and medical records of patients with stroke diagnosed by neurology and control group were measured by ELISA method to detect the levels of BP180 antibody and BP230 antibody. Results: BP180 antibodies were detected in 89 stroke patients and 101 control subjects. The positive rate of BP180 antibody in stroke group was significantly higher than that in control group (12.4% vs 4.0% vs 0.032%). The positive rate of serum BP230 antibody in stroke group was higher than that in control group (14.7% vs 5.9% vs 0.231%), but there was no significant difference. Conclusion: the positive rate of BP antibody in stroke group is higher than that in control group. The third part: the cognitive function of patients with bullous pemphigoid was studied. Objective: to study the cognitive impairment of BP patients. Methods: to use the MMSE scale and Moca scale to evaluate the cognitive function of patients with pemphigoid bullous. Methods: to study the cognitive function of patients with bullous pemphigoid. The cognitive function of patients with BP and control group was evaluated. Results: 20 patients in BP group and 24 subjects in control group were assessed with MMSE scale. It was found that the total score of MMSE in the BP group was significantly lower than that in the control group (0.039%), and the rate of cognitive impairment was significantly higher than that in the control group (25%) vs 4.2% (0.045%), 19 patients in the BP group and 24 subjects in the control group were assessed with Moca scale. It was found that the scores of Moca correction in BP patients were significantly lower than those in the control group, but there was no significant difference in the rate of cognitive impairment between the two groups. Conclusion: compared with the control group, the cognitive impairment in the BP group is more serious.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R743.3;R758.66

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 ;Outline of the Report on Cardiovascular Disease in China,2010[J];Biomedical and Environmental Sciences;2012年03期

相關(guān)博士學(xué)位論文 前1條

1 李麗;大皰性類天皰瘡與神經(jīng)系統(tǒng)損害發(fā)病機(jī)制關(guān)系初探[D];中國協(xié)和醫(yī)科大學(xué);2006年

，

本文編號(hào)：1583379