Pathological And Clinical Retrospective Analysis Of 145 Cases Of Bullous Pemphigoid

Bullous pemphigoid(BP)is an autoimmune bullous disease that typically affects the elderly and,on occasion,children and adolescents.A crucial clinical feature of this disease is itchy,tense blisters covering normal skin or erythematous and edematous skin on the trunk and extremities with potential mucosal involvement.Nikolsky’s sign is negative in this disease.Many studies have been conducted on the process of autoantibody binding,which triggers cascade reactions,the recruitment of inflammatory cells,and the release of chemokines and proteases.The relationships between lesion inflammatory cells infiltrations,levels of autoantibodies,eosinophil counts in the circulation,total IgE levels,disease severity,and complications have,however,not been extensively studied.ObjectivesWe examined the relationships among inflammatory cellular infiltrations,antiBP180 and anti-BP230 IgG autoantibody levels,blood eosinophil counts,total IgE levels,disease severity,and complications to explore autoimmune factors and type II inflammatory factors contributed to BP pathogenesis and provided new insight into treatments.MethodsWe reviewed and analyzed clinical and pathological data for 145 patients with BP diagnosed in a hospital between January 2019 and December 2022 for the following factors:lesion inflammatory cell infiltrations,anti-BP180,anti-BP230 autoantibody levels,blood eosinophil counts,total IgE levels,disease severity(BPDAI),and complications.Results1.BPDAI was positively correlated with the eosinophil infiltrations(P=0.013,correlation coefficient 0.348)and the neutrophil infiltrations(P=0.031,correlation coefficient 0.306).Infiltrations of eosinophils were positively correlated with the infiltrations of neutrophils(P<0.001,correlation coefficient 0.625).There was a positive correlation between the total IgE levels and the blood eosinophil counts(P=0.007,correlation coefficient 0.282).2.Total IgE levels were different among groups with different neutrophil infiltration levels,and IgE levels were lower when neutrophil infiltration levels were high(P=0.026).There was a negative correlation between neutrophil infiltrations and the total IgE levels(P=0.048,correlation coefficient-0.205).3.There were comorbidities present in most patients.In terms of complications,there were no statistically significant differences between groups with different levels and types of inflammatory cell infiltrations,except for when the degree of neutrophil infiltrations were high,in which the proportion of patients with complications was higher(P=0.005).4.The total IgE levels of the double-positive group was higher than that of the single-positive group,and there was a positive correlation between the anti-BP230 antibody levels and the serum total IgE levels(P<0.001,correlation coefficient 0.434).The level of anti-BP180 antibody was positively correlated with eosinophil count in blood(P=0.022,correlation coefficient 0.200),and the level of anti-BP180 antibody was negatively correlated with the degree of lymphocyte infiltration(P=0.020,correlation coefficient-0.193).In a partial correlation analysis using age as a control variable,a greater correlation was found between the double-positive group and coronary heart disease,hypertension,diabetes,and other skin diseases than the singlepositive group.ConclusionsIn our study,the relationships between inflammatory cell infiltrations,serum total IgE levels,blood eosinophil counts,anti-BP180 antibody levels,anti-BP230 antibody levels,disease severity(BPDAI)and complications were investigated.The autoimmune factors and the Th2 inflammatory factors in the pathogenesis of BP were analyzed through the results.