| Objective:To analyze the risk factors of oral candida infection in patients with immune bullous disease by collecting clinical data of 86 patients with the disease diagnosed by the dermatology department of the First Affiliated Hospital of Dalian Medical University.For the cases with positive fungi microscopic examination,the fungi culture and color culture were further improved,and the pathogenic bacteria were clarified to guide the clinical practice and take preventive measures to reduce the incidence of oral Candida infection.Methods: Retrospective analysis of the clinical data of 86 admitted patients with immune bullous disease in our dermatology department from January 2012 to September 2018,were analyzed for the risk factors likes gender,age,natural history,the taking time,initial dose and cumulative dose of corticoid,the use of cyclosporine.Species identification : For the cases showing positive fungal microscopic examination from October 2017 to September 2018,fungi culture and color culture were carried out by using Sabouraud Dextrose Agar Slant and CHROMagar chromogenic medium.Results:1.Of the 86 patients collected,42 were positive for oral Candida infection and 44 were negative,with a positive rate of 48.8%.This indicates that the incidence of oral candida infection in patients with clinically immune bullous disease is very high.2.Collect general clinical data of patients: Among the 86 patients,47 of which had pemphigus,39 had bullous pemphigoid;35 are male patients,51 are female patients;47 are 70 years old and above,39 are below;the natural history were from 10 days to 9 years.The cumulative dose of corticoid was 0-1g in 26 cases,10 cases of 1-2g,8cases of 2-3g,42 cases were more than 3g;the initial dose was between 20 mg and100mg;the corticoid taking time was between 2 days and 9 years.19 was onset in spring,27 in summer,23 in autumn,and 17 in winter.;17 were suffer from COPD,20 had chronic gastritis,and 28 patients are hypertensive.;15 cases with hemoglobin<120g/L,and 71 were more than 120g/L;29 are diabetic;48 had hypoproteinemia;24were put on cyclosporine;and the using dose of cyclosporine is between 200 mg and23.7g.To go on univariate analysis on above factors which are gender,age,type of blister,natural history,the taking time,initial dose and cumulative dose of corticoid,the onset season,use and cumulative dose of cyclosporine,the underlying disease(HTN,DM,COPD,chronic gastritis,hypoproteinemia)and laboratory examination(Hb).According to whether there is a oral Candida infection,the experimental components are divided into 2 groups.The results show:(1)For general influence factors: the PR of pemphigus patients was 48.9%(23/47),and the PR of bullous pemphigoid was 48.7%(19/39).The PR for male was 45.7%(16/35),and the positive rate for female was 51%(26/51).The positive rate of patients aged ≥70 years was 61.7%(29/47),and the positive rate of <70 years old was33.3%(13/39).The mean natural history of the positive group was 26.48±31.81(months),and the negative group was 13.18±28.00(months).(2)For corticoid using: the positive rate of oral Candida in patients with 0-1 g cumulative dose was 23.1.%(6/26),1-2g was 40%(4/10),2-3g was 50%(4/8),and >3g was 66.7%(28/42).The average dose in the positive group was 54.16±20.37(mg)and negative group was 48.07±17.16(mg).The average taking time in the positive group was 19.97±26.84(day)and the negative group was 9.28±24.96(day).(3)For the seasonal factors,the onset positive rate was 52.6%(10/19)in spring,33.3%(9/27)in summer,60.9%(14/23)in autumn,and 52.9%(9/17)in winter.(4)For the underlying disease: the positive rate of Candida was 64.7%(11/17)in patients with Chronic obstructive pulmonary disease(COPD),and was 44.9%(31/69)without.The positive rate was 40%(8/20)in patients with chronic gastritis,and was51.5%(34/66)without.The positive rate was 50%(14/28)in patients with hypertension(HTN),and was 48.3%(28/58)without.For Hb(Hemoglobin)≥120g/L,the positive rate of Candida was 46.5%(33/71),and for Hb <120g/L was 60%(9/15).The positive rate of Candida was 82.8%(24/29)in patients with DM(diabetes mellitus),and was 31.6%(18/57)without.The positive rate was 75%(36/48)in patients with hypoproteinemia,and was 15.8%(6/38)without.(5)For the using of cyclosporin,the positive rate of candida was 66.7%(16/24)in patients who were using of cyclosoprin,and was 41.9%(26/62)who were not.Among the 24 patients who were putting on cyclosporin,the cumulative dose in the positive group was 10.18±7.45(g),and 6.21±7.54(g)in the negative group.By chi-square test or t-test,the statistically relevant factors(P<0.05)are the using and cumulative dose of corticoid,the using of cyclosporin,DM,hypoproteinemia,old age and natural history.Type of blister,sex,initial dose and taking time of corticoid,cumulative dose of cyclosporin,Hb <120g / L,and patients who were suffering from chronic gastritis,COPD,HTN,were not statistically relevant.3.Multivariate logistic regression analysis was performed on the above meaningful factors(the using and cumulative dose of corticoid,the using of cyclosporin,DM,hypoproteinemia,old age and natural history).The results showed that the cumulative dose of corticoid,DM,hypoproteinemia,and the using of cyclosporin were all P<0.05,and the OR values were all >1.The difference was statistically significant.4.Species identification: From October 2017 to September 2018,a total of 25 patients with positive fungi microscopic examination in our hospital were treated with fungi culture.The colonies were milky white,smooth and moist,suggesting that they were all Candida infections;Further improved by color culture,a total of 24 strains showed green,were Candida albicans;for the 1 strain in purple,was Candida glabrata.Conclusions:1.The incidence of oral candida infection in patients with immune bullous disease is close to 50%.2.Risk factors of oral candida infection in patients with immune bullous disease are:old age(≥70 years),long natural history,cumulative dose of corticoid(>3g),with DM,witn hypoproteinemia and the using of cyclosporin.Independent risk factors are: cumulative dose of corticoid(>3g),with DM,with hypoproteinemia,and the using of cyclosporin.3.The dominant pathogen of patients with immune bullous disease who suffer from an oral infection is Candida albicans. |
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