血浆疗法治疗大疱性类天疱疮的临床疗效及自身抗体水平变化
|
摘要
目的:通过研究大疱性类天疱疮(bullous pemphigoid, BP)患者的临床资料,提高对大疱性类天疱疮的认识,并初步评价血浆疗法治疗大疱性类天疱疮的临床疗效,并探索其治疗机制。方法:2009年12月—2015年12月我院皮肤科收治的大疱性类天疱疮患者66例,28例患者接受血浆疗法联合糖皮质激素治疗,作为血浆疗法组(PT组),38例患者单纯应用糖皮质激素治疗,作为单纯糖皮质激素治疗组(HT组),比较两组的临床疗效,每组各采集16名患者的血清,以20名健康者血清作为对照,采用酶联免疫吸附(ELISA)法检测治疗前后血清中抗BP180抗体水平的变化以及抗BP180抗体亚型IgG1、IgG4水平的变化。结果:PT组有效率为92.86%,HT组为73.68%,PT组的治疗效果更为显著。两组患者治疗后抗BP180抗体滴度明显下降(P<0.01),PT组较HT组下降明显(P<0.01),PT组患者治疗后抗体亚型IgG1、IgG4测得的吸光度A值明显下降(P<0.05)。结论:血浆疗法治疗大疱性类天疱疮有效,其机制可能与降低抗BP180抗体及抗体亚型IgG1、IgG4的水平有关。
Objective: Through the study of the clinical data of patients with bullous pemphigoid(BP) to improve the understanding of BP, and to assess the experience with plasma therapy in the treatment of bullous pemphigoid and to explore the mechanism. Methods: Analysis of the clinical data of 66 patients with bullous pemphigoid treated in our hospital from December 2009 to December 2015. The patients were assigned into PT group(28 cases) or HT group(38 cases). To Comparise the clinical efficacy of the two groups. Each group selected 16 cases with serum, and 20 cases with healthy serum as a control, The antibody levels of BP180 and the subtype IgG1 and IgG4 were declined. Results: After treatment, the effective rate of plasma therapy group was 92.86%, 73.68% in pure hormone treatment group. After treatment, the autoantibody BP180 titer of the two groups significantly declined(P<0.01), the decreased of autoantibody titer were more in PT group than in HT group(P <0.01). After PT treatment, the autoantibody subtype IgG1 and IgG4 titer significantly declined(P <0.05), the decreased of subtype titer were more in PT group than in HT group(P<0.01). Conclusion: Plasma therapy is an effective mean in treating bullous pemphigoid. The mechanism may be related to decrease the level of autoantibody against BP180 and antiBP180 IgG subclasses.
Objective: Through the study of the clinical data of patients with bullous pemphigoid(BP) to improve the understanding of BP, and to assess the experience with plasma therapy in the treatment of bullous pemphigoid and to explore the mechanism. Methods: Analysis of the clinical data of 66 patients with bullous pemphigoid treated in our hospital from December 2009 to December 2015. The patients were assigned into PT group(28 cases) or HT group(38 cases). To Comparise the clinical efficacy of the two groups. Each group selected 16 cases with serum, and 20 cases with healthy serum as a control, The antibody levels of BP180 and the subtype IgG1 and IgG4 were declined. Results: After treatment, the effective rate of plasma therapy group was 92.86%, 73.68% in pure hormone treatment group. After treatment, the autoantibody BP180 titer of the two groups significantly declined(P<0.01), the decreased of autoantibody titer were more in PT group than in HT group(P <0.01). After PT treatment, the autoantibody subtype IgG1 and IgG4 titer significantly declined(P <0.05), the decreased of subtype titer were more in PT group than in HT group(P<0.01). Conclusion: Plasma therapy is an effective mean in treating bullous pemphigoid. The mechanism may be related to decrease the level of autoantibody against BP180 and antiBP180 IgG subclasses.
引文
[1]Kasperkiewicz M,Zillikens D,Schmidt E.Pemphigoid diseases:pathogenesis,diagnosis and treatment[J].Autoimmunity,2012,45(1):55-70.
[2]王明悦,王佩茹,彭洋,等.BP180抗原与自身免疫性大疱性皮肤病的研究进展[J].免疫学杂志,2014,30(10):926-929.
[3]赵辩.临床皮肤病学[M].3版.江苏:科学技术出版社,2001:806.
[4]Roujeau JC,Lok C,Bastuji-Garin S,et al.High risk of death in elderly patients with extensive bullous pemphigoid[J].Arch Dermatol,1998,134(4):465-469.
[5]Venning VA,Taghipour K,Mohd Mustapa MF,et al.British Association of Dermatologists’guide-lines for the management of bullous pemphigoid[J].Br J Dermatol,2012,167(6):1200-1214.
[6]Khumalo NP,Murrell DF,Wojnarowska F,et al.A systematic review of treatments for bullous pemphigoid[J].Arch Dermatol,2002,138(3):385-389.
[7]李金勇,丁惠玲,毕兴杰.糖皮质激素联合小剂量静脉注射用人免疫球蛋白和血浆成功治疗重症天疱疮2例[J].临床皮肤科杂志,2009,38(4):262-263.
[8]胡彩霞,王文氢,吴学工,等.血浆置换治疗天疱疮及大疱性类天疱疮的临床分析及血清抗体水平检测[J].临床皮肤科杂志,2017,46(8):552-555.
[9]Kirtschig G,Middleton P,Bennett C,et al.Interventions for bullous pemphigoid[J].Cochrane Database Syst Rev,2010,10:CD002292.
[10]高天文,廖文俊,李珍妮,等.血浆输注及血浆置换治疗重症皮肤病.临床皮肤科杂志[J],2002,31(5):301-302.
[11]Hofmann S,Thoma Uszynski S,Hunziker T,et al.Severity and phenotype of bullous pemphigoid relate to autoantibody profile against the NH2-and COOH-terminal regions of the BP180ectodomain[J].J Invest Dermatol,2002,119(5):1065-1073.
[12]Zhou XP,Zuo YG,Liu B,et al.Ig G subclasses targeting NC16A domain of BP180 in bullous pemphigoi[J].Natl Med JChina,2013,93(32):2529-2533.
[2]王明悦,王佩茹,彭洋,等.BP180抗原与自身免疫性大疱性皮肤病的研究进展[J].免疫学杂志,2014,30(10):926-929.
[3]赵辩.临床皮肤病学[M].3版.江苏:科学技术出版社,2001:806.
[4]Roujeau JC,Lok C,Bastuji-Garin S,et al.High risk of death in elderly patients with extensive bullous pemphigoid[J].Arch Dermatol,1998,134(4):465-469.
[5]Venning VA,Taghipour K,Mohd Mustapa MF,et al.British Association of Dermatologists’guide-lines for the management of bullous pemphigoid[J].Br J Dermatol,2012,167(6):1200-1214.
[6]Khumalo NP,Murrell DF,Wojnarowska F,et al.A systematic review of treatments for bullous pemphigoid[J].Arch Dermatol,2002,138(3):385-389.
[7]李金勇,丁惠玲,毕兴杰.糖皮质激素联合小剂量静脉注射用人免疫球蛋白和血浆成功治疗重症天疱疮2例[J].临床皮肤科杂志,2009,38(4):262-263.
[8]胡彩霞,王文氢,吴学工,等.血浆置换治疗天疱疮及大疱性类天疱疮的临床分析及血清抗体水平检测[J].临床皮肤科杂志,2017,46(8):552-555.
[9]Kirtschig G,Middleton P,Bennett C,et al.Interventions for bullous pemphigoid[J].Cochrane Database Syst Rev,2010,10:CD002292.
[10]高天文,廖文俊,李珍妮,等.血浆输注及血浆置换治疗重症皮肤病.临床皮肤科杂志[J],2002,31(5):301-302.
[11]Hofmann S,Thoma Uszynski S,Hunziker T,et al.Severity and phenotype of bullous pemphigoid relate to autoantibody profile against the NH2-and COOH-terminal regions of the BP180ectodomain[J].J Invest Dermatol,2002,119(5):1065-1073.
[12]Zhou XP,Zuo YG,Liu B,et al.Ig G subclasses targeting NC16A domain of BP180 in bullous pemphigoi[J].Natl Med JChina,2013,93(32):2529-2533.