| Background Bullous pemphigoid is an autoimmune dermatosis that predominantly occurs in the elderly.It is clinically characterized by generalized tense vesicles,bu lla,erosions and crusts on the ground of edematous erythemas.The patients often complain of intense itching.Sepsis,hypoproteinemia and the imbalance of electrocytes can occur in the severe cases.The pathogenesis of BP remains unclear.Ig G and Ig E type autoantibodies directing against hemidesomosomes of basement membrane zone are identified in the skin tissues and blood from BP patients by direct immunofluoresence,indirect immunofluoresence,immunoblot and ELISA.Some studies have showed that T cell-mediated immunity is involved in thedevelopment of BP as well as humoral immunity in the recent years.CD4+ T cells include Th1,Th2,Th17,Treg and Th22.Th1 cells mainly produce IL-2,IL-12,IL-18,IFN-γ,while Th2 cells secrete IL-4,IL-5,IL-6,IL-10 and IL-13.Treg cells mainly produce IL-10 and TGF-β.The cytokines of Th17 cells are IL-17,IL-22,IL-23 and IL-25.In addition,the cytokines of Th22 cells are IL-13,IL-22 and IL-26.These cytokines promote and have an influence each other,and participate in the pathogenesis of BP together,eventually causing erythema and formation of vesicle and bulla.Objectives To investigate the role of IL-17、IL-18、IL-22 and IL-25 in the pathogenesis of BP and the relation between these four cytokines and clinical phenotypes of BP patients.Methods The case-control study is used.The clinical data and blood samples are collected from 40 BP patients before and after treatment and 40 healthy controls.The serum level of IL-17,IL-18,IL-22 and IL-25 is detected by ELISA in all subjects,then we compare the difference in the serum level of IL-17,IL-18,IL-22 and IL-25 between BP patients before treatment and healthy controls,between BP patients after treatment and healthy controls,and between BP patients beforetreatment and BP patients after treatment by using T tests.The Pearson analysis is used to analyze the relationship between the serum level of IL-17,IL-18,IL-22 and IL-25 and the clinical phenotypes of BP patients.Results 1.The mean level of IL-17,IL-18,IL-22 and IL-25 in the BP patients before treatment and after treatment was respectively 50.22±17.49ng/L,117.11±39.04ng/L,39.30±15.30ng/L,55.19±24.82ng/L and 47.22±25.40ng/L,109.54±47.7ng/L,35.96±23.3ng/L,49.59±41.48ng/L,and significantly higher than that of healthy controls(14.50±2.77ng/L,58.79±17.70ng/L,14.81±2.74ng/L,21.95±4.71ng/L).Both the difference in the serum level of IL-17,IL-18,IL-22 and IL-25 between BP patients before treatment and healthy controls and the difference between BP patients after treatment and healthy controls are statistically significant(P<0.001),whereas it was not statistically significant for the difference in the serum level of these four cytokines between BP patients before treatment and BP patients after treatment(P>0.05).2.The average levels of IL-17,IL-18,IL-22 and IL-25 in the sera of male BP patients were 49.68±18.50 ng/L,101.48±27.16 ng/L,33.60±9.50 ng/L,52.90±6.62 ng/L,and 50.66±17.05 ng/L,129.89±43.05 ng/L,47.91±26.19 ng/L,57.05±4.75 ng/L in the female BP patients.The levels of IL-18 and IL-22 in female patients were higher than those of male patients,and the difference was statistically significant(P<0.05).3.The mean levels of IL-17,IL-18,IL-22 and IL-25 in the sera of patients with mild BP were 42.05±5.53 ng/L,110.17±36.43 ng/L,31.32±5.71 ng/L,43.63±9.99 ng/L,and 78.69±28.23 ng/L,158.85±59.27 ng/L,71.71±23.03 ng/L,104.63±42.78 ng/L in the patients with moderate to severe BP.The expression levels of IL-17,IL-18,IL-22,and IL-25 in the sera of moderate-severe BP patients were significantly higher than those of mild BP patients,and the differences were statistically significant(P<0.001).4.There was a correlation between serum IL-17,IL-22,IL-25 and disease activity in BP patients(P<0.001);There was no correlation between these four cytokines and total Ig E level、eosinophils in the peripheral blood(P>0.05).Conclusions The levels of IL-17,IL-18,IL-22 and IL-25 in the sera of BP patients are strikingly increased,and are related to the severity of disease in parallel.It is suggested that Th17 is involved in the pathogenesis of BP.Moreover,the serum level of IL-17,IL-18,IL-22 and IL-25 can be used as indicator to evaluate the severity of disease and clinical efficacy in BP. |
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