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大疱性类天疱疮合并结核感染4例及文献复习

左亚刚,  晋红中,  王宏伟,  乔菊,  刘跃华,  刘洁,  孙秋宁,  王家璧

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文章导航 > 协和医学杂志  > 2012 >  3(4): 375-380
左亚刚, 晋红中, 王宏伟, 乔菊, 刘跃华, 刘洁, 孙秋宁, 王家璧. 大疱性类天疱疮合并结核感染4例及文献复习[J]. 协和医学杂志, 2012, 3(4): 375-380. doi: 10.3969/j.issn.1674-9081.2012.04.003
引用本文: 左亚刚, 晋红中, 王宏伟, 乔菊, 刘跃华, 刘洁, 孙秋宁, 王家璧. 大疱性类天疱疮合并结核感染4例及文献复习[J]. 协和医学杂志, 2012, 3(4): 375-380. doi: 10.3969/j.issn.1674-9081.2012.04.003
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Ya-gang ZUO, Hong-zhong JIN, Hong-wei WANG, Ju QIAO, Yue-hua LIU, Jie LIU, Qiu-ning SUN, Jia-bi WANG. Bullous Pemphigoid Complicated with Tuberculosis: Report of 4 Cases and Literature Review[J]. Medical Journal of Peking Union Medical College Hospital, 2012, 3(4): 375-380. doi: 10.3969/j.issn.1674-9081.2012.04.003
Citation: Ya-gang ZUO, Hong-zhong JIN, Hong-wei WANG, Ju QIAO, Yue-hua LIU, Jie LIU, Qiu-ning SUN, Jia-bi WANG. Bullous Pemphigoid Complicated with Tuberculosis: Report of 4 Cases and Literature Review[J]. Medical Journal of Peking Union Medical College Hospital, 2012, 3(4): 375-380. doi: 10.3969/j.issn.1674-9081.2012.04.003
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大疱性类天疱疮合并结核感染4例及文献复习

doi: 10.3969/j.issn.1674-9081.2012.04.003

  • 中国医学科学院 北京协和医学院 北京协和医院皮肤科, 北京 100730

基金项目: 

国家自然科学基金 81071301

教育部新世纪优秀人才项目 NCET-10-0964

详细信息
    通讯作者:

    左亚刚 电话:010-69156393, E-mail:zuoyagang@263.net

  • 中图分类号: R758.66

Bullous Pemphigoid Complicated with Tuberculosis: Report of 4 Cases and Literature Review

  • Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

More Information

    摘要
  • 摘要:   目的  探讨大疱性类天疱疮(bullous pemphigoid, BP)合并结核杆菌感染的临床、实验室和诊治特点。  方法  回顾性分析1990年1月至2012年4月北京协和医院皮肤科4例住院的有完整记录的BP合并结核杆菌感染患者的临床资料, 总结其诊治规律。  结果  4例患者中3例结核菌素(purified protein derivative, PPD)试验阴性, 1例阳性。4例患者的嗜酸性粒细胞水平明显升高, 且与病情相平行。3例患者采用皮质类固醇激素和利福平为主的三联抗痨药, 1例采用异烟肼、乙胺丁醇、吡嗪酰胺和皮质类固醇激素治疗; 2例皮质类固醇激素剂量超过180 mg/d。3例患者皮损全部消退, 结核感染得到控制。2例静脉点滴人免疫球蛋白有短期疗效。  结论  对于长期应用皮质类固醇激素的BP患者仔细筛查潜在的结核感染至关重要。在皮质类固醇激素应用患者中, PPD试验可出现假阴性。为此, 若同时应用皮质类固醇激素与利福平, 皮质类固醇激素的剂量应增加一倍以上。此外, 人免疫球蛋白也是治疗BP合并结核感染的一种较好方法。
    Abstract:   Objective  To explore the clinical and laboratory characteristics of bullous pemphigoid (BP) complicated with tuberculosis.  Methods  The clinical data of 4 inpatients with BP complicated with tuberculosis, who were diagnosed and treated in Department of Dermatology, PUMC, from January 1990 to April 2012, were retrospectively analyzed, and meanwhile the relevant literature was reviewed.  Results  Purified protein derivative (PPD) test showed negative results in three patients and positive in the remaining one patient. The level of eosinophils in all these 4 cases remarkably increased and was parallel with the severity of the disease. Three patients received rifampicin and prednisone combination therapy and the remaining one patient was treated with isoniazide, ethambutal, pyrazinamide, and corticosteroid. The dose of prednisone exceeded 180 mg/d in 2 patients. Clinical complete remission of bulla was achieved in 3 patients, and tuberculosis was also controlled. Intravenous immunoglobulin showed short-term efficacy in 2 patients.  Conclusions  The potential tuberculosis infection should be carefully screened in BP patients who have received long-term steroid treatment. PPD often shows false negative results in these patients. If rifampicin and prednisone are used in combination, the dose of prednisone should be increased by at least two fold. Furthermore, intravenous immunoglobulin provides a good alternative treatment for BP with tuberculosis.
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    • 参考文献(13)
  • [1] Wu J, Dalal K. Tuberculosis in asia and the pacific:the role of socioeconomic status and health system development[J]. Int J Prev Med, 2012, 3:8-16. http://medpharm.tandfonline.com/servlet/linkout?suffix=CIT0018&dbid=8&doi=10.1080%2F23120053.2017.1321243&key=22355472
    [2] Menzies D, Pai M, Comstock G. Meta-analysis:new tests for the diagnosis of latent tuberculosis infection:areas of uncertainty and recommendations for research[J]. Ann Intern Med, 2007, 146:340-354. doi:  10.7326/0003-4819-146-5-200703060-00006
    [3] McAllister WAC, Thompson PJ, Al-Habet SM, et al. Rifampicin reduces effectiveness and bioavailability of prednisolone[J]. Br Med J, 1983, 286:923-925. doi:  10.1136/bmj.286.6369.923
    [4] Pai M, Zwerling A, Menzies D. Systematic review:T-cellbased assays for the diagnosis of latent tuberculosis infection:an update[J]. Ann Intern Med, 2008, 149:177-184. doi:  10.7326/0003-4819-149-3-200808050-00241
    [5] Shovman O, Anouk M, Vinnitsky N, et al. QuantiFERON ®-TB Gold in the identification of latent tuberculosis infection in rheumatoid arthritis:a pilot study[J]. Int J Tuberc Lung Dis, 2009, 13:1427-1432. http://www.cabdirect.org/abstracts/20093359519.html
    [6] Papay P, Eser A, Winkler S, et al. Factors impacting the results of interferon-γ release assay and tuberculin skin test in routine screening for latent tuberculosis in patients with inflammatory bowel diseases[J]. Inflamm Bowel Dis, 2011, 17:84-90. doi:  10.1002/ibd.21427
    [7] 陈金波, 刘洁, 王宝玺.利福平对糖皮质激素治疗大疱性类天疱疮的干扰[J].临床皮肤科杂志, 2009, 38:239-241. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lcpfkzz200904014
    [8] Ibn Sellam A, Soualhi M, Zahraoui R, et al. A rare form of rifampicin-induced skin toxicity:Bullous pemphigoid[J]. Rev Mal Respir, 2011, 28:365-371. doi:  10.1016/j.rmr.2010.09.031
    [9] Bernard P, Venot J, Constant F, et al. Blood eosinophilia as a severity marker for bullous pemphigoid[J]. J Am Acad Dermatol, 1987, 16:879-881. http://www.ncbi.nlm.nih.gov/pubmed/3553250
    [10] Cugno M, Tedeschi A, Asero R, et al. Skin autoimmunity and blood coagulation[J]. Autoimmununity, 2010, 43:189-194. doi:  10.3109/08916930903293086
    [11] Toosi S, Bystryn JC. Potential role of interleukin-17 in the pathogenesis of bullous pemphigoid[J]. Med Hypotheses, 2010, 74:727-728. doi:  10.1016/j.mehy.2009.10.038
    [12] 左亚刚, 刘冰, 李丽, 等.嗜酸性粒细胞水平与大疱性类天疱疮激素应用剂量间的关系[J].中国医学科学院学报, 2012, 34:130-133. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgyxkxyxb201202006
    [13] Nanda A, Nanda M, Dvorak R, et al. Bullous pemphigoid (BP) in an infant complicated by tuberculous meningoencephalitis[J]. Intern J Dermatol, 2007, 46:964-966. doi:  10.1111/j.1365-4632.2007.03194.x
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出版历程
  • 收稿日期:  2012-07-30
  • 刊出日期:  2012-10-30

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