■大疱性类天疱疮(BP)和单纯疱疹病毒(HSV)感染在口腔粘膜中的表现相似,HSV的实验室检测有一定的局限性,这使得在BP的口腔病变中难以识别HSV感染。此外,BP和HSV感染的治疗存在矛盾。因此,及时发现BP患者的HSV感染非常重要。
■确定单纯疱疹病毒感染在BP口腔病变中的患病率和临床标志物。
■这项前瞻性横断面描述性分析研究是对42例有口腔病变的BP患者进行的。32例无口腔病变的BP患者和41例健康者作为对照组。采用聚合酶链反应检测HSV。比较HSV感染患者与未感染患者的临床和实验室特征。
■共有19例(45.2%)有口腔病变的BP患者,无(0.0%)血压无口腔病变患者,4例(9.8%)健康个体在口腔粘膜上的HSV阳性。在有口腔病变的BP患者中,口腔和皮肤病变之间的不一致活性(p=0.001),口腔病变中没有水泡/血泡(p=0.020),与HSV阴性BP患者相比,HSV阳性BP患者的口腔病变疼痛(p=0.014)更常见;HSV阳性BP患者的糖皮质激素剂量(p=0.023)和最近2周的累积糖皮质激素剂量(2周AGC剂量)(p=0.018)更高。结合以上五个变量作为测试变量,在ROC分析中,AUC为0.898(p<0.001),HSV感染为状态变量。在多变量分析中,发现口腔病变中没有水泡/血泡(p=0.030)和口腔病变疼痛(p=0.038)是HSV感染的独立预测因子。共有14例(73.7%)HSV阳性BP患者接受2周泛昔洛韦治疗,口腔粘膜BPDAI评分显著下降(p<0.001)。
■HSV感染常见于BP口腔病变。口腔和皮肤病变之间的不一致活动,口腔病变中没有水疱,口腔病变疼痛,目前使用的糖皮质激素剂量较高,在BP患者中,较高的2周AGC剂量应提醒医生注意口腔病变中的HSV感染,并及时给予2周泛昔洛韦治疗.
UNASSIGNED: The manifestations of bullous pemphigoid (BP) and herpes simplex virus (HSV) infection are similar in oral mucosa, and the laboratory detection of HSV has some limitations, making it difficult to identify the HSV infection in oral lesions of BP. In addition, the treatments for BP and HSV infection have contradictory aspects. Thus, it is important to identify the HSV infection in BP patients in time.
UNASSIGNED: To identify the prevalence and clinical markers of HSV infection in oral lesions of BP.
UNASSIGNED: This prospective cross-sectional descriptive analytical study was conducted on 42 BP patients with oral lesions. A total of 32 BP patients without oral lesions and 41 healthy individuals were enrolled as control groups. Polymerase chain reaction was used to detect HSV. Clinical and laboratory characteristics of patients with HSV infection were compared with those without infection.
UNASSIGNED: A total of 19 (45.2%) BP patients with oral lesions, none (0.0%) BP patients without oral lesions, and four (9.8%) healthy individuals were positive for HSV on oral mucosa. Among BP patients with oral lesions, the inconsistent activity between oral and skin lesions (p=0.001), absence of blister/blood blister in oral lesions (p=0.020), and pain for oral lesions (p=0.014) were more often seen in HSV-positive than HSV-negative BP patients; the dosage of glucocorticoid (p=0.023) and the accumulated glucocorticoid dosage in the last 2 weeks (2-week AGC dosage) (p=0.018) were higher in HSV-positive BP patients. Combining the above five variables as test variable, the AUC was 0.898 (p<0.001) with HSV infection as state variable in ROC analysis. The absence of blister/blood blister in oral lesions (p=0.030) and pain for oral lesions (p=0.038) were found to be independent predictors of HSV infection in multivariable analysis. A total of 14 (73.7%) HSV-positive BP patients were treated with 2-week famciclovir and the oral mucosa BPDAI scores significantly decreased (p<0.001).
UNASSIGNED: HSV infection is common in BP oral lesions. The inconsistent activity between oral and skin lesions, absence of blister in oral lesions, pain for oral lesions, higher currently used glucocorticoid dosage, and higher 2-week AGC dosage in BP patients should alert physicians to HSV infection in oral lesions and treat them with 2-week famciclovir in time.