【摘要】：1.78例大皰性類天皰瘡診療回顧 目的:大皰性類天皰瘡是臨床較常見的自身免疫性水皰病，發(fā)病機理復(fù)雜，其臨床表現(xiàn)及實驗室診斷有一定的特點，易合并其它內(nèi)科疾病。我們通過對我院78例大皰性類天皰瘡患者進行臨床回顧性分析，以期進一步研究其臨床特點、治療方案等，為臨床診療提供可靠的依據(jù)。 方法:收集大連市皮膚病醫(yī)院2007年1月-2012年1月期間診治的78例住院患者，對其發(fā)病年齡、皮損特點、病情嚴重程度、組織病理、免疫病理、是否合并神經(jīng)系統(tǒng)癥狀、治療方案等列表登記，進行總結(jié)并分析。 結(jié)果:本組資料共78例，其中男41例，占52.56%，女37例，占47.43%，平均發(fā)病年齡74.01±9.49歲，病情輕度28例，中度41例，重度9例，其中13例患者伴有粘膜損害，占16.6%，皮損嚴重程度與治療時間呈正比，臨床表現(xiàn)、病理檢查與免疫熒光檢查一致率為69.23%。其中15例合并神經(jīng)系統(tǒng)疾病，占19.23%%，系統(tǒng)應(yīng)用糖皮質(zhì)激素是治療的主要手段，也可聯(lián)合應(yīng)用免疫抑制劑治療，對重癥療效欠佳或激素禁忌癥者可應(yīng)用丙種球蛋白沖擊治療。 2.CXCR5在類天皰瘡皮損中的表達及臨床意義 目的:檢測濾泡輔助性T細胞（Tfh）趨化因子受體-5（CXCR5）在大皰性類天皰瘡患者皮損中的表達，分析和探討CXCR5在大皰性類天皰瘡發(fā)病機制中的作用。方法:應(yīng)用免疫組織化學(xué)SP法，檢測16例大皰性類天皰瘡患者皮損及10例正常人皮膚組織中CXCR5表達。 結(jié)果: CXCR5在正常皮膚組織表達于基底細胞層，主要表達于細胞質(zhì)、細胞膜處，在大皰性類天皰瘡皮損組織中表達于基底細胞層與棘細胞層，表達水平顯著高于正常對照組織，有顯著性差異（p0.5）。 結(jié)論: CXCR5在大皰性類天皰瘡患者皮損中表達較正常人皮膚組織增多，，提示Tfh(CXCR5)在大皰性類天皰瘡的發(fā)病機制中起著極為重要的作用。 總結(jié)論: 1.大皰性類天皰瘡好發(fā)于老年人，性別對其發(fā)病無統(tǒng)計學(xué)差異。 2.組織病理、免疫熒光是確診BP的主要方法。 3.可合并系統(tǒng)疾病以神經(jīng)系統(tǒng)疾病為主。 4.糖皮質(zhì)激素是控制疾病的主要治療方法，可聯(lián)合應(yīng)用免疫抑制劑。 5.對重癥療效欠佳或有激素應(yīng)用禁忌癥者可選擇丙種球蛋白沖擊治療。 6.CXCR5在正常皮膚組織表達于基底細胞層，主要表達于細胞質(zhì)、細胞膜處，在大皰性類天皰瘡皮損組織中表達于基底細胞層與棘細胞層，表達水平顯著高于正常對照組織。 7.Tfh(CXCR5)在大皰性類天皰瘡的發(fā)病機制中起著極為重要的作用。
[Abstract]:1. Review of diagnosis and treatment of 78 cases of bullous pemphigoid: bullous pemphigoid is a common autoimmune vesicular disease with complicated pathogenesis, and its clinical manifestations and laboratory diagnosis have some characteristics. It is easy to concomitant with other internal diseases. Through the retrospective analysis of 78 cases of bullous pemphigoid in our hospital, we hope to further study its clinical characteristics, treatment plan and so on, so as to provide reliable basis for clinical diagnosis and treatment. Methods: 78 inpatients were collected from January 2007 to January 2012 in Dalian Dermatological Hospital. Their age of onset, characteristics of skin lesions, severity of disease, histopathology, immunopathology and neurological symptoms were analyzed. A list of treatment regimens is registered, summarized and analyzed. Results: there were 78 cases, including 41 males (52.56%) and 37 females (47.43%). The average age of onset was 74.01 鹵9.49 years old. 28 cases were mild, 41 cases were moderate and 9 cases were severe. Among them, 13 cases were accompanied by mucosal damage. It was 16.6%. The severity of skin lesions was proportional to the treatment time. The consistent rate between pathological examination and immunofluorescence examination was 69.23%. Among them, 15 cases (19.23%) were complicated with nervous system diseases. Systemic application of glucocorticoid was the main treatment method, and it could also be treated with immunosuppressive agents. Patients with severe adverse effects or hormonal contraindications can be treated with gamma globulin shock therapy. The expression of 2.CXCR5 in pemphigoid lesions and its clinical significance objective: to detect the expression of (Tfh) chemokine receptor-5 (CXCR5) on follicular helper T cells in patients with pemphigoid bullosa. To investigate the role of CXCR5 in the pathogenesis of bullous pemphigoid. Methods: immunohistochemical SP method was used to detect the expression of CXCR5 in the skin of 16 patients with bullous pemphigoid and 10 normal skin tissues. Results: CXCR5 was expressed in the basal cell layer, mainly in the cytoplasm and cell membrane, and in the basal cell layer and spinous cell layer in the pemphigoid bullous lesions, and the expression level was significantly higher than that in the normal control tissue. There was significant difference (p0.5). Conclusion: the expression of CXCR5 in the lesions of patients with bullous pemphigoid is higher than that in normal human skin, suggesting that Tfh (CXCR5) plays an important role in the pathogenesis of bullous pemphigoid. General conclusions: 1. Bullous pemphigoid is more common in the elderly, and there is no statistical difference in the incidence of bullous pemphigoid. 2. Histopathology and immunofluorescence are the main methods for the diagnosis of BP. 3. Diseases of the nervous system may be associated with diseases of the nervous system. 4. Glucocorticoid is the main therapeutic method to control diseases and can be used in combination with immunosuppressive agents. 5. Patients with severe adverse effects or contraindication of hormone use can be treated with gamma globulin shock therapy. 6.CXCR5 was expressed in the basal cell layer, mainly in the cytoplasm and cell membrane, and in the basal cell layer and spinous cell layer in the pemphigoid bullous lesions. The expression level was significantly higher than that in the normal control tissue. 7.Tfh (CXCR5) plays an important role in the pathogenesis of bullous pemphigoid.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R758.66

【參考文獻】

相關(guān)期刊論文 前4條

1 李麗;王寶璽;陳霞;;大皰性類天皰瘡合并神經(jīng)系統(tǒng)疾病22例臨床分析[J];北京醫(yī)學(xué);2006年05期

2 尹迪;徐鳳花;戚中田;;補體C3d作為分子佐劑的研究進展[J];中國肝臟病雜志(電子版);2008年02期

3 劉曉依;潘萌;鄭捷;;大皰性類天皰瘡的臨床路徑與預(yù)后初探[J];中國皮膚性病學(xué)雜志;2011年01期

4 耿士玲;單士軍;吳劍;王志華;肖汀;高興華;陳洪鐸;;大皰性類天皰瘡皮損中Th1/Th2趨化因子及其受體的表達[J];中國免疫學(xué)雜志;2010年03期

本文編號：2445661