Clinical Effect Of Plasma Therapy On Bullous Pemphigoid And Its Relationship With Related Cytokines

Objective:Bullous pemphigoid(BP)is a serious autoimmune bullous skin disease,occurring in the elderly,skin lesions often accompanied by severe itching and skin blister,ulceration and erosion,severe life-threatening,serious impact on the quality of life of patients.Despite the continuous improvement of treatment,BP’s annual mortality is still high,the literature reported 13% to38%.With the aging of society,the incidence of patients showed a rapid growth trend.It is imminent to seek a treatment that can be accepted by most patients with less side effects.Plasma exchange can be effective in patients with inflammatory mediators and pathogenic antibodies,while reducing the amount of glucocorticoid,reducing the side effects of glucocorticoids.It has a very good effect on the treatment of severe bullous pemphigoid.But the plasma replacement price is expensive,increase the burden on patients,limited the application.Therefore,our department using intermittent plasma infusion method for the treatment of some patients with bullous pemphigoid,and achieved some achievements.This study analyze the clinical data of patients with bullous pemphigoid treated in our hospital for nearly six years,summarizing the clinical features,histopathological examination and so on.The changes of antibody titer,antibody subtype and related cytokine levels in patients with bullous pemphigoid before and after treatment are compared by different treatments,analyzing the relationship between cytokines and disease,evaluating the therapeutic effect of.Plasma therapy(including plasma exchange and plasma infusion)on bullous pemphigoid.At the same time,the paper discusses the treatment mechanism and provides new ideas for clinical treatment.Methods:Analysis of the clinical data of 111 patients with bullous pemphigoid treated in our hospital from December 2009 to December2015.The patients were treated with different treatment methods including plasma therapy and hormone therapy.The levels of IgG1 and Ig G4 in the serum of BP180 antibody in 20 healthy subjects were significantly higher than those in the control group(P<0.05),and the levels of anti-BP180 antibody titers and related cytokines IL-5,IL-6,IL-8,IL-10,IL-13,IL-18,TNF-α and IFN-γ.All statistical analysis is performed using SPSS21.0 software.The data were expressed as((x|-)±s),and the count data was expressed as(n,%).Result:1 Clinical results:1)In general,of the 111 patients,62 are male(55.86%)and 49 are female(44.14%).The age range is 6 to 94 years(mean,68.32±16.43 years).The incidence of patients over the age of 70 account for 63.97%.From the Nepalese sign,among 111 patients,the negativewas 98 cases,suspicious positivein 8 cases,positive in 5 cases.Of the 111 patients,54 are with cardiovascular disease,9 are coronary heart disease,45 are hypertension,22 are with cerebrovascular disease,16 are with diabetes.Histopathological examination:108 patients for Subcutaneous blister,positive rate was 98.20%.2)Treatment effect:After treatment,the plasma therapy group effective rate is 92.31%,the hormone therapy group is 78.94%.3)Adverse reactions:Plasma therapy group patients do not appear adverse reactions.Hormone therapy group showes 7 cases of adverse reactions(3 cases of increase in blood glucose,1 case of abnormal liver function,3 cases of oral fungal infection).2 Experimental results:1)Anti-BP180 antibody titer:The anti-BP180 antibody titer were significantly decreased after treatment(P<0.01).2)Antibody subtype:Patients with bullous pemphigoid exists IgG1,Ig G4 antibody subtype.There is no significant difference in the positive rate of IgG subtypes before treatment.The positive rates are IgG1(85%)>IgG4(75%).The positive rate of IgG subtypes decreases after treatment,but there is no significant difference.There is no significant difference between the subtypes.The positive rate are IgG1(75%)>Ig G4(55%).3)Cytokine IL-5,IL-6,IL-8,IL-10,IL-13,IL-18,TNF-α,IFN-γ levels:The levels of IL-5,IL-10,IL-13,IL-18 and IFN-γ in patients with bullous pemphigoid are significantly higher than those in normal control group(P<0.05).There is no significant difference in IL-6,IL-8 and TNF-α between bullous pemphigus and normal control group.IL-5,IL-10,IL-13,IL-18 and IFN-γ are significantly decreased after treatment(P<0.05).Comparison of plasma therapy and hormone therapy,the use of plasma therapy after the decline in the index increased(P<0.05).Conclusion:1 Bullous pemphigoid patients were more common in the elderly over the age of 70.Bullous pemphigoid mostly patients were with hypertension,cerebrovascular disease and diabetes.2 Bullous pemphigoid treatment of plasma therapy was effective,it had less side effects.3 Patients with bullous pemphigoid existed IgG1,IgG4 antibody subtype.Before the treatment,the positive rate of IgG1 antibody subtype was higher than IgG4 antibody subtype.The positive rate of Ig G antibody subtypes were significantly decreased after the treatment.It was suggested that IgG antibody subtypes are associated with disease activity.4 IL-5,IL-10,IL-13,IL-18 and IFN-γ weree involved in the pathogenesis of bullous pemphigoid,responsing to the treatment of patients.Plasma therapy had a significant therapeutic effect on patients with bullous pemphigoid by reducing these pathogenic cytokines in the body.