Study On The Level Of BP Antibody In Patients With Stroke And The Cognitive Function Of Bullous Blister

Background:Bullous pemphigoid (BP) is a rare autoimmune disease, which mainly occurs in the elderly population. Many epidemiological studies suggest that BP patients are more likely to associate with various neurological diseases (NDs), and the most common NDs reported are dementia and stroke. The mechanism is not clear yet. Hypothesis suggests that the autoantibodies against the BP180/230 antigens in the brain may cross-react with antigens in the skin.Part 1.Objectives:To investigate the neurological comorbidities among patients with BP in China. Methods:We collected and analyzed the clinical information of the BP cases diagnosed in Peking Union Medical College Hospital during Dec.2011 to Jan.2015. A retrospective study was made to compare the difference of gender, age as well as other clinical factors between two BP patients’subgroups (with or without NDs). Results:At least one ND was present in 14 of the 63 BP patients. They primarily consisted of stroke (9/14,64.3%) and dementia (3/14,21.4%). Conclusion:Our study confirmed the high frequency of NDs, particularly dementia and stroke, in BP patients. All the NDs happened before the diagnosis of BP.Part 2.Objectives:To investigate the BP180/230 antibodes’occurrence among the patients with stroke. Methods:We collected the sera of the stroke patients diagnosed in Peking Union Medical College Hospital during Jun.2014 to Jan.2015. Enzyme-linked immunosorbent assay (ELISA) was applied to compare the occurrence of BP180/230 antibodies between stroke and control groups. Results:89 sera samples of stroke paients and 101 of controls were analysed with ELISA for BP180 antibody. The positive rate of BP180 antibody in stroke group was significantly higher than the control group (12.4% vs 4.0%, p=0.032).34 sera samples of stroke paients and controls were analysed with ELISA for BP230 antibody, and the positive rate of BP230 antibody in stroke group was higher than the control group as well (14.7% vs 5.9%, p=0.231), while it did not reach statistic significance.Conclusion:The positive rate of BP antibodies in the stroke group is higher than the control group, and the difference is significant for BP180 antibody.Part 3.Objectives:To study the cognitive status in BP patients. Methods: Mini-mental state examination (MMSE) and Montreal Cognitive Assessment (Moca) were applied to the BP group and the control group to assess potential cognitive impairment. Results:The MMSE was applied to 20 BP paients and 24 controls. The scores of the scale in the BP group are significantly lower than the control’s (p=0.002), and the rate of cognitive impairment of BP group is significantly higher than the control group (25% vs 4.2%, p=0.045), according to the modified cutoff. Moca was applied to 19 BP paients and 24 controls. The modified scores of the scale in the BP group are significantly lower than the control’s (p=0.039), while the difference of cognitive impairment rate did not reach statistic significance. Conclusion:Comparing to the control group, the BP patients suffered more severe cognitive impairment.