Retrospective Analysis Of 104 Cases Of Bullous Pemphigoid Specialty:clinical Integrated Chinese And Western Medicine

Objectives:Through the retrospective study on the medical records of hospitalized patients with bullous pemphigoid(BP)from Guangdong Hospital of Traditional Chinese Medicine from 2007 to 2017,analyzed the clinical characteristics of BP,found out the characteristics of distribution of TCM syndromes and general situation of treatment of traditional Chinese medicine,explored the relevant factors affecting the prognosis of BP,which could provide some useful reference for the treatment of this disease in the future,and provide some evidence for improving the quality of life and survival time of BP patients in the future.Method:We reviewed medical record information of 104 hospitalized patients diagnosed as BP from 2007 to 2017 in the Guangdong Hospital of Traditional Chinese Medicine,including general data,clinical manifestations,laboratory examination results,comorbidities,traditional and western medicine therapy records and efficacy.In addition,we followed up the patients by telephone to obtain information about survival situation,and analyzed the relevant factor affecting the prognosis of BP.Result:1.Among the 104 inpatients,61(58.7%)were male and 43(41.3%)were female,and the ratio of male to female were 1.4:1.The average age of onset was 70.85±14.18 years old,and there were 88 cases(84.6%)of patients aged above 60 years.There was no significant difference in the age of onset between different genders(P>0.05).2.The initial manifestation were erythema,papules,blisters or bullae.Most of lesions distributed in limbs firstly,and predominated on the trunk and limbs.100 patients have symptoms with mild to severe pruritus alone or in association with painful.3.There are 27 patients had involvement of the oral cavity(26%),and 4 of them appeared oral mucosal erosion as the first manifestation of lesions.Patients with the involvement of the oral cavity were more severe than those without the involvement,and the difference was statistically significant(P<0.05).4.75 cases of patients accompanied with other comorbidities(72.1%),including cardiovascular disease,nervous system disease,diabetes,other skin diseases,malignant tumors and kidney disease,accounting for 51.9%,25.0%,23.1%,20.2%,5.8%and 5.8%,respectively.The comorbidity of malignant tumors was a risk factor affecting the prognosis of patients of BP.A total of 6 cases accompanied with malignant tumors,and 5 of them were related to lung meridian of traditional Chinese medicine.Theories of "lung govern skin and hair","lung open into the nose" and "lung and large intestine have relevance " of traditional Chinese medicine may provide a theoretical basis for explaining the intrinsic relationship between BP and respiratory malignant tumors.5.The TCM syndromes of BP were mainly composed of spleen deficiency with dampness accumulation and dampness-heat.Chinese herbal medicine mainly included tonifying medicines,heat-clearing medicines and dampness-draining medicines.6.102 cases(98.0%)were treated with combination of traditional and western medicine,1 case(1.0%)was treated with traditional Chinese medicine alone,1 case(1.0%)was treated with western medicine alone,and the effective rate of treatment was 96.2%.Corticosteroids was the mainly therapeutic alternative of western medicine,and the difference of the initial dose,the maximum dosage,the cumulative dosage and the average dosage of corticosteroids between the different disease severity groups was statistically significant(P<0.05).The more serious the condition was,the more dosage of corticosteroids was used.7.A total of 104 medical records were reviewed in this study,74 patients with BP were followed up finally,and the rate of loss of follow-up was 28.8%.8.Logistic regression of multivariate analysis revealed that bedridden condition and abnormal chest imaging results were risk factors for the survival time of BP.In addition,bedridden condition,abnormal chest imaging results and malignant tumors were associated with the elevated 1-year mortality of BP.Conclusion:1.BP is a disease of the elderly,with an onset above 60 years of age.There was no significant difference in the age of onset between different genders.And more than one or more other comorbidities are combined,mainly with cardiovascular disease and nervous system disease.2.Patients with the involvement of the oral cavity were more severe than those without involvement of it.The more serious the condition was,the more initial dosage,maximum dosage,cumulative doseage and average dosage of corticosteroids was used.3.Spleen deficiency with dampness accumulation and dampness-heat are important pathogenesis of Chinese medicine of BP.Therapy of TCM mainly base on invigorating spleen,tonifying,clearing heat and draining dampness.4.While treating BP patients who were elder,bedridden and had abnormal chest imaging result,it is necessary to exclude carcinoma,which is conducive to improve patients' quality of life and survival time.