| Objective: To analyze the clinical characteristics,laboratory tests,treatment options and efficacy,infection and its risk factors of pemphigus patients diagnosed and treated in our department in recent years,to explore occurrence regularity and clinic a l manifestations,treatment efficacy,as well as the location of the concurrent infect io n,the pathogenic bacteria and antimicrobial resistance,and the effects on treatment and prognosis,this study has certain practical significance for guiding clinical work.Method: Retrospective analysis of patients with pemphigus hospitalized in the Department of Dermatology from the Second Hospital of Lanzhou University from January 2014 to September 2019.All cases were diagnosed with pemphigus clinica l ly and/or histopathologically.Clinical data of 109 hospitalization records from 70 patients with pemphigus was selected by inclusion and exclusion criteria,Analyzed by SPSS 22.0 software.Results:1)The hospitalization records of 109 cases of 70 patients were included in this study.there were 34 male patients(55 cases)and 36 female patients(54 cases)Among them,the ratio of male to female was 1.06,the average onset age was 50.77 ±12.08(19~80)years,and the average hospitalization age was 52.95 ±11.60(20~80)years.The onset age and hospitalization age of female patients were 47.94 ±12.62(19~72)years and 49.89 ±12.36(20~74)years respectively,which were earlier than those of male patients,53.74 ±10.86(35~80)years(t=2.062,P=0.043)and 55.96 ±10.03(37~80)years(t=2.812,P=0.006).The onset age and hospitalization age of patients with pemphigus were mostly between 40 and 60 years old.The most common init i a l sites were oral cavity(30%),head-face-neck(26%)and chest(19%).2)The average init ia l dosage of glucocorticoids in pemphigus patie nt s after admissio n was(44.54 ±22.97)mg in mild patients,(62.41 ±22.75)mg in moderate patients,and(90.00 ±12.91)mg in severe patients,and ther e was significa nt differe nce among differe nt disease severity in pemphig us patient(F=16.086,P=0.000).There were statistica l ly signif ica nt differe nc e s in WBC,NE%,PLT and ALB among differe nt disease severity(F=5.934,P=0.004;F=3.30,P=0.040;F=4.223,P=0.017;F=13.017,P=0.000),The more serious the illness,the longer the length of stay and the higher the cost of hospitalizat io n(F=16.314,P=0.000;F=30.519,P=0.000).3)Among the 109 patients with pemphigus,66 were complicated with infect io n,with an infection rate of 60.55%,39 with single-system infection and 27 with mult isystem infection.The average age of co-infection group was(50.23 ±9.43)years old,and that of non-infection group was(57.14 ±13.36)years old,the difference was statistically significant(t=2.947,P=0.004),pemphigus patients aged under 50 years old were more likely to be complicated with infection than those older than 50(χ2=4.17,P=0.041).Sex,place of residence,course of disease,diabetes mel itus and the number of chronic diseases had no significant effect on infection in pemphigus patients(χ2=0.075,P=0.785;χ2=3.409,P=0.065;χ2=0.828,P=0.661;χ2=0.094,P=0.759;χ2=0.203,P=0.652);Pemphigus patients with oral involvement were more likely to be complicated with infection than those oral non-involvement(χ2=6.477,P=0.011).There was significant difference in complicated infection among different disease severity(χ2=17.505,P=0.000).The infection rate of severe patients(100%)was significantly higher than that of moderate(74.14%)and mild(36.36%),and there was significant difference between moderate and mild patients(χ2=14.640,P=0.000).The severity of the disease was an independent risk factor for pemphigus patients with infection(OR=5.008,P=0.001).4)The numbers of NE%,PLT,ALB and hypoproteinemia in the co-infectio n group were significantly different from those in the non-infection group(t=2.172,P=0.034;t=2.026,P=0.045;t=3.948,P=0.000;χ2=8.158,P=0.004).There was no significant difference in the number of WBC between the two groups(t=1.841,P=0.068).The average initial dosage of glucocorticoids after admission was(60.30 ±27.47)mg in the co-infection group and(51.86 ±20.96)mg in the non-infec t io n group,and there were no significant difference between the two groups(t=1.815,P=0.072).The average length of stay and the average cost of hospitaliza t io n in the co-infection group were significantly higher than those in the non-infection group [(13.21±5.89)days vs(8.79±2.41)days,(t=5.439,P=0.000);(9830.38±5779.24)yuan vs(4596.00±1726.24)yuan,(t=4.248,P=0.000)].5)The main site of infection source was skin lesion(81.82%),mainly Staphylococcus aureus(57.58%),followed by oral cavity,mainly fungal infect io n(80.00%),fungal infection in oral involvement patients accounted for 19.30%,oral noninvolved patients accounted for 5.77%,oral involvement was more likely to develop fungal infection(χ2=6.303,P=0.012).6)The detection rate of MDRO was 40.79%,mainly MRSA(58.06%),The resistance rate of Staphylococcus aureus to fluoroquinolones,ceftriaxone and ampicillin / sulbactam was less than 50%.The resistance rate to clindamycin and erythromycin was more than 90%.7)The disease control remission rate of discharged patients was 95.41%,and the remission rate of severe patients(57.14%)was significantly lower than that of mild-tomoderate patients(98.04%)(χ2=16.560,P=0.000).There was no significant differe nce between the remission rate of co-infection(93.94%)and that of non-coinfec t io n(97.67%)(χ2=0.196,P=0.658).Conclusion: The onset age and hospitalization age of patients with pemphigus were mostly between 40 and 60 years old,and the ratio of male to female was 1:1.06.The onset age of female was significantly earlier than that of male.The infection rate of patients with pemphigus was 60.55%.Age,oral involvement,severity of the disease and hypoproteinemia were the risk factors of pemphigus complicated with infect io n,and the severity of the disease was the independent risk factors of complicated infect io n.Infectio n did not signif ica nt ly increase the initia l dosage of glucocortico ids in pemphigus patients.The main pathogens of infection are Staphylococcus aureus from skin.The detection rate of MDRO was high,mainly MSRA from skin lesion.The resistance rate of Staphylococcus aureus to fluoroquinolones,ceftriaxone and ampicillin / sulbactam was low.The remission rate of discharged patients was high,and the remission rate of severe patients was significantly lower than that of patients with mild-to-moderate.infection has no significant effect on the remission rate. |
