CAJ | 학술논문

目的：总结45例初次住院的大疱性类天疱疮患者的临床特点及治疗经验。方法分析2009年8月—2014年12月45例住院治疗的大疱性类天疱疮患者临床表现、组织病理、免疫病理、治疗方案及并发症等方面的情况。结果45例住院患者86.67%为老年人，均表现为瘙痒性紧张性大疱，普通组织病理表现为表皮下水疱，直接免疫荧光检查见IgG和（或）C3在基膜带呈线状沉积。6例患者转科或自动出院，入院时均存在低白蛋白血症。余39例患者好转或临床治愈出院，总有效率为86.67%。39例患者中9例单纯使用糖皮质激素治疗，30例糖皮质激素联合免疫抑制剂治疗（主要为甲氨蝶呤）。单纯糖皮质激素治疗组的住院天数显著少于糖皮质激素联合免疫抑制剂治疗组（P＜0.05）。糖皮质激素联合使用免疫抑制剂治疗感染发生率更高（P＜0.05）。结论系统使用糖皮质激素是大疱性类天疱疮患者住院治疗的首选，视病情联合免疫抑制剂治疗可以增加疗效，但感染发生率会增加，要警惕低白蛋白血症的危险性。
목적：총결45례초차주원적대포성류천포창환자적림상특점급치료경험。방법분석2009년8월—2014년12월45례주원치료적대포성류천포창환자림상표현、조직병리、면역병리、치료방안급병발증등방면적정황。결과45례주원환자86.67%위노년인，균표현위소양성긴장성대포，보통조직병리표현위표피하수포，직접면역형광검사견IgG화（혹）C3재기막대정선상침적。6례환자전과혹자동출원，입원시균존재저백단백혈증。여39례환자호전혹림상치유출원，총유효솔위86.67%。39례환자중9례단순사용당피질격소치료，30례당피질격소연합면역억제제치료（주요위갑안접령）。단순당피질격소치료조적주원천수현저소우당피질격소연합면역억제제치료조（P＜0.05）。당피질격소연합사용면역억제제치료감염발생솔경고（P＜0.05）。결론계통사용당피질격소시대포성류천포창환자주원치료적수선，시병정연합면역억제제치료가이증가료효，단감염발생솔회증가，요경척저백단백혈증적위험성。
Objective To summarize the clinical features and therapeutic experience of 45 ifrst hospitalization cases of bullous pemphigoid. Methods To analyze the clinical manifestations, histopathology, direct immunolfuorescence, treatment and complications of ifrst-time hospitalized patients with bullous pemphigoid admitted in department of dermatology, the First Afifliated Hospital of Nanjing Medical University from August 2009 to December 2014. Results Thirty nine of 45 inpatients were the elderly. Almost all the patients showed intense bullae with pruritus. Histopathology revealed subepidermal bulla, and the direct immunolfuorescence showed there were IgG and/or C3 linear deposition at basement membrane zone. Six of 45 patients who against advice were discharged or clinical transferred, and they all had hypoalbuminemia on admission. The other 39 patients were discharged from hospital after recovery or improvement, with total effective rate of 86.67%. Nine of 39 patients were treated with systemic glucocorticoids only. The other 30 patients were treated with glucocorticoids combined with immunosuppressant (methotrexate mainly). The hospital days of glucocorticoids-only group were signiifcantly less than glucocorticoids combined with immunosuppressant group (P<0.05). Incidence of infection was obviously higher in glucocorticoids combined with immunosuppressant group (P<0.05). Conclusions Systemic glucocorticoids therapy is the ifrst choice for hospitalized patients with bullous pemphigoid. Glucocorticoids combined with immunosuppressant could enhance the therapeutic effect, however, the incidence of infection would increase. The risk of hypoalbuminemia should be paid attention to.