A Retrospective Analysis On Bullous Pemphigoid Patients Treated With Systematic Glucocorticoid And Intravenous Immunoglobulin

Objective:To investigate the clinical efficacy and safety of IVIG and glucocorticoid in the treatment of bullous pemphigoid,and provide reference for bullous pemphigoid therapeutic method selection.Methods:Hospitalized patients have been collected in Qilu Hospital of Shandong University during January 2015 to April 2017,who were confirmed the diagnosis of bullous pemphigoid on the basis of the clinical manifestations,pathological and immunofluorescence examination.According to the treatment prescription during hospitalization,patients are divided into three groups,GC group,GC+IVIG group and GC+ISD group.40 patients embedded in our clinical research were between 4-6 points according to the evaluation of Japanese bullous pemphigoid disease activity standard(jBPAS).Peripheral blood eosinophil(EOS)count system,glucocorticoid dosage and hospitalization days were recommended to evaluate the curative effect.The rate of adverse events and systemic antibiotics(except minocycline)was assessed the safety of Human Immunoglobulin.Result:40 patients with BP were collected,including GC group(n =21),GC+IVIG group(n= 12)and GC+ISD group(n = 7).There was no significant difference between these three groups in gender,age and course of disease(P>0.05).1.Eosinophil countBefore treatment,eosinophils(EOS)count of GC group,GC+IVIG group and GC+ISD group is(1.288±1.488)*10^9/L,(1.354±0.874)*10^9/L,(0.295±0.651)*10^9/L.There is no significant difference between three groups(P=0.358).After treatment,eosinophils(EOS)count of GC group is(0.443±0.742)*10^9/L,(0.295±0.651)*10^9/L in GC+IVIG group,and(0.076±0.090)*10^9/L in GC +ISD group.There is no significant difference between three groups(P=0.131).But the rank sum test of paired samples test showed that EOS of GC+IVIG group and GC +ISD group decreased significantly after treatment(P=0.025;P=0.017),There is no significant difference between before and after treatment in GC group(P=0.066).2.The dosage of glucocorticoidThe dosage of glucocorticoid in GC group is(53.29±29.12)mg/d,(32.33 ±7)mg/d in GC+IVIG group,(107.1±42.6)mg/d in GC +ISD group.There is a significant difference between three groups(P=0.001).The dosage of glucocorticoid in GC+IVIG group was significantly reduced compared with GC group and GC+ISD group(P=0.022;P<0.001,M-W test).In addition,we compared the difference between the three groups by the amount of glucocorticoid per kg of body weight.In GC group,daily use of systemic corticosteroids was(1.03±0.69)mg/kg,(0.45±0.13)mg/kg in GC+IVIG group,and(1.56±0.52)mg/kg in GC+ISD group.There is a significant difference between three groups(H=17.924,P<0.0001 Kruskal-Wallis test).Daily use of systemic corticosteroids in GC+IVIG group was significantly reduced compared with GC group and GC+ISD group(adjusted P=0.014;adjusted P<0.001).But there is no significant difference between GC group and GC+ISD group(adjusted P=0.221).3.Hospitalization daysThe average length of hospitalization in GC group was(9.6±4.1)d,(8.1 ±3.7)d in GC+IVIG group,(16.4±7.6)d in GC+ISD group.There was a significant difference between the three groups(P=0.011).No significant difference was found between GC+IVIG group and GC group(P>0.05).The length of hospitalization in GC+IVIG group was significant reduced Compared with GC+ISD group.(P=0.012,M-W test;P=0.017,K-S test).4.Adverse reactions17 of the 40 patients occurred in adverse reactions,including 7 cases of hyperglycemia or poor control of blood glucose,2 cases of cutaneous infection,1 case of Malassezia Folliculitis and dysfunction of liver,4 cases of pulmonary infection owing to the use of GC and/or ISD,and 1 case of headache associated with the use of IVIG who had a remission after taking a rest.The occurrence of adverse reactions in GC+IVIG group had no significant difference with the GC group and GC+ISD group(P=0.704;P=0.315,Fisher exact test).Conclusion:1.When the patients with bullous pemphigoid are insensitivity or intolerance with high-dose systemic corticosteroids and/or immunosuppressant,the therapeutic regimen of systemic corticosteroids combined with intravenous immunoglobulin is a effective alternative,which can effectively and significantly reduce the eosinophil count in peripheral blood and the dosage of systemic corticosteroids.2.The treatment perscription of systemic corticosteroids combined with intravenous immunoglobulin is has high security.The adverse reaction is mild and self-limitated.