Clinical Analysis Of 105 Patients With Pemphigus Vulgaris

Objective: In our hospital,105 patients with pemphigus vulgaris were analyzed and summarized in terms of general condition,clinical manifestations,infection,treatment and efficacy,so as to provide more references for the treatment of pemphigus vulgaris,with the aim of early control of the condition,reducing complications and improving the prognosis.Methods: The medical records of 105 pemphigus vulgaris patients hospitalized in the second hospital of Jilin University from January 2010 to January 2020 were collected,and the patients’ age,gender,mucosal involvement,infection,treatment regimens,prophylactic antifungal agents and efficacy were entered into the Excel forms,and the data were analyzed by spss23.0.Results: 1.General Conditions: Among the 105 patients with pemphigus vulgaris,45 were male and 60 were female,the ratio of male to female was 1:1.33.The age of onset ranged from 25 to 82 years,with a mean age of onset of 53.72±12.90,and the age of predilection ranged from 41 to 50 years.The median duration of the disease was 3.00 months,ranging from 0.13 to 60.50 months at the time of visiting our hospital.2.Clinical Features: All patients had skin involvement and those with mucosal involvement accounted for 73.33% of all patients,including approximately 93.51% of patients with oral mucosal involvement.There were 40 cases of oral mucosa,28 cases of head and neck,26 cases of trunk,and 11 cases of extremities in the initial sites of skin lesions.The positive rate of nikolsky sign in pemphigus vulgaris patients was 89.52%.33 of 105 patients(31.43%)were misdiagnosed with other diseases out of hospital,of which oral ulcers were most often misdiagnosed.3.Treatment And Efficacy of Pemphigus Vulgaris: Only 24 patients were treated with hormone therapy,and 81 patients were treated with hormone combined with immunosuppressant.There were significant differences between disease severity and the starting dose of hormone,control dose of hormone,cumulative dose of hormone and total amount of hormones before the reduction(P<0.05).The differences between the hormone group and the combination group in the cumulative dose of hormone,the total amount before dose reduction and the duration of hospitalization were statistically significant(P<0.05).The differences between the hypoalbuminemia and nonhypoalbuminemia groups in the hormone’s starting dose,control dose,cumulative dose and total amount before dose reduction were statistically significant(P<0.05).The differences between the infected and noninfected groups in the hormone’s controlled dose,cumulative dose and total amount before dose reduction were statistically significant(P<0.05).4.Susceptibility Factors For Oral Candida Infection: The differences in oral mucosal involvement,hypoalbuminemia,and diabetes mellitus were statistically significant for oral Candida infection(P<0.05).The differences in the controlled dose,cumulative dose and total amount before dose reduction of glucocorticoids,length of hospital stay were statistically significant for oral Candida infection(P<0.05).The difference of oral Candida infection between the two groups in the cumulative dose of hormones ≥1g and <1g was statistically significant(P<0.05).The combination of immunosuppressant,frequent replacement of antibiotics,broad-spectrum antibiotic courses,and antibiotic species showed statistically significant differences in oral Candida infection(P<0.05).5.Antifungal treatment for prevention: The difference between the prophylaxis group and the no prophylaxis group on oral Candida infection was statistically significant(P<0.05).Prophylactic medication within 1 week of admission and prophylactic medication after 1 week of admission the difference between the two groups in oral Candida infection was statistically significant(P<0.05).The difference in the prophylactic course between the group with and without oral Candida infection was statistically significant(P<0.05),and the difference between the prophylactic course of itraconazole and infection was statistically significant(P<0.05).When divided into≥15 days and <15 days based on the course of prophylactic treatment with itraconazole,there was a statistically significant difference in oral Candida infection between the two groups(P<0.05).The differences among fluconazole,itraconazole and terbinafine in preventing oral Candida infection were not statistically significant(P>0.05).Conclusions: 1.Disease severity,immunosuppressant,hypoalbuminemia,and infection are important factors affecting hormone dosage in patients,and the application of hormone dosage in patients should follow individualized principles.2.Susceptibility factors for oral Candida infection were diabetes mellitus,glucocorticoid dose,concomitant immunosuppressant,hospitalization days,hypoalbuminemia,oral mucosal breakdown,courses of antibiotics,frequent antibiotic replacement,and types of antibiotics.3.Antifungal prophylaxis can reduce the occurrence of oral Candida infection,and antifungal agents should be administered prophylactically within 1 week of admission.