| BackgroundBullous pemphigoid(BP)is an autoimmune skin disease that frequently occurs in the elderly population.Epidemiological studies have suggested an association between BP and neurological diseases(ND).It has been reported that patients with BP were significantly more likely to have dementia,cerebrovascular disease,Parkinson disease,multiple sclerosis,and amyotrophic lateral sclerosis.Nevertheless.there are few articles published exploring the diffrences in aspects of clinical characteristics and laboratory results between BP with or without ND.ObjectiveTo study the clinical features and laboratory results of the patients who were diagnosed with BP with or without ND by retrospective analysis and provide references for the diagnosis and treatment of BP companied by ND.MethodsTo collect the related data of the BP cases that were diagnised and hospitalized for the first time in Qilu Hospital Affiliated to Shandong University from January 2010 to June 2016.Patients were divided into Group BP + ND and Group BP-ND according to with or without neurological disorders respectively,and the differences in aspects of clinical features and laboratory results between the two groups were analyzed.SPSS(22.0 version)software was used for statistical analysis and P<0.05 is regarded as statistically significant.Results34 patients were divided into Group BP+ND and 17 patients were divided into Group BP-ND in this study,BP patients with nervous system diseases accounted for 33.3%.1.Gender:In the two groups,there are 24 male patients and 27 female patients in total;in Group BP-ND,there are 15 male patients and 19 female patients,while in Group BP+ND,there are 9 male patients and 8 female patients.There was no statistically significant difference in gender composition between the two groups(P =0.056).2.Onset age:In Group BP-ND,the mean age of onset is 70.1(95%CI 65.8-74.4),with a range from 36 to 87,and in Group BP+ND that is 76.1(95%CI 72.0-80.0),with a range from 60 to 90.The statistical difference between the two groups was not significant(P =0.211).3.Neurological diseases:Among 22 patients diagnosed with both BP and ND,including 17 patients of Group BP+ND and 5 patients diagnosed with both BP and ND who were excluded from Group BP+ND for meeting one of the exclusion criterias.The most frequent diseases are cerebrovascular diseases,of which 12 patients have cerebral infarction,and 2 patients have cerebral hemorrhage;3 cases suffered from Parkinson disease and one of them also has cerebral infarction;2 patients are suffering from Denmentia,one with AD,and the other with both mixed dementia and cerebral infarction;2 patients have brain atrophy;1 patient has prolapse of lumbar intervertebral disc and Spinal canal stenosis.4.Time interval between BP and ND:The mean time of ND prior to the onset of BP was 8.1 years(95%CI 4.2-12.0 years),with the range from 0 to 20 years and the median time interval was 7.0 years.A patient was diagnosed with BP several days before his cerebaral infaction.5.Course before diagnosis:In Group BP-ND,the mean duration from the onset to accurate diagnosis of BP is 4.7 months(95%CI 2.3-7.1 months),compared with 3.3 months(95%CI 0.1-6.4 months)in Group BP+ND.No significantly statistical difference is found between the two groups(P=0.131).6.Eosinophils:The mean eosinophil count and its percentage in peripheral blood are 0.77*109/L(95%CI 0.28-1.27*109/L)and 6.31%(95%CI 3.28-9.33%)respectively in Group BP-ND,and 0.70*109/L(95%CI 0.31-1.09*109/L and 7.45%(95%CI 3.70-11.21%)respectively in Group BP+ND;in Group BP-ND,29.4%of the patients had elaveted eosinophil count and/or percentage in peripheral blood,and in Group BP+ND,it was 52.9%;the differences above between the two groups had no statistical significance(P>0.05).7.Total IgE in serum:The mean level of total IgE in serum was 1952 IU/ml(95%CI 742-3616 IU/ml)in Group BP-ND and 4232 IU/ml(95%CI 1741-6721 IU/ml)in Group BP+ND,and the difference between the two groups was not significant(P=0.061).8.Dosage of corticosteroids:Dosage of systematic glucocorticoid of two groups during hospitalization were converted to the dosage of prednisone.In Group BP-ND the average of maximum glucocorticoid dosage to control the condition was 69.3 mg/d(95%CI 56.5-82.1 mg/d),higher than that in Group BP+ND,which was 54.6 mg/d(95%CI 43.8-65.3 mg/d);in Group BP-ND,the mean duration of maximum glucocorticoid dosage to control the condition was 9.1 days(95%CI 7.3-10.9 days),which is longer than 8.5 days(95%CI 6.2-10.7 days)in Group BP+ND;the average of total glucocorticoid dosage was 710.3mg(95%CI 533.9-886.7 mg)in Group BP-ND,higher than 464.0mg(95%CI 330.9-597.2 mg)in Group BP+ND,but the all the differences had no statistical significance(P>0.05).The differences of the indexs above still had no statistical significance after the exclusion of immune inhibitors(P>0.05).Conclusions1.The most common neurological disease with BP is cerebrovascular diseases,and the mean time interal between ND and BP is 8.1 years.2.The course before diagnosis,the total serum IgE,eosinophils,and maximum glucocorticoid dosage to control the condition in initial treatment between the two groups have no significant difference. |
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