Role of physical factors in the pathogenesis of bullous pemphigoid: Case report series and a comprehensive review of the published work
Role of physical factors in the pathogenesis of bullous pemphigoid: Case report series and a comprehensive review of the published work
复制标题
DOI：
10.1111/1346-8138.13031
复制
发表时间：
2016-02-01
影响因子：
3.1
通讯作者：
Baican, Adrian
中科院分区：
文献类型：
--
作者：
Danescu, Sorina;Chiorean, Roxana;Baican, Adrian
大疱性类天疱疮是一种自身免疫性表皮下水疱性疾病，主要发生于老年人。由物理因子引起的疾病亚型代表了一种罕见的，因此，特征不充分的形式。在本研究中，我们的目的是有助于更好地了解参与发病的BP不同触发因素引起的发病机制。我们回顾性分析了9例BP病例。根据临床、流行病学和免疫学参数对所有患者进行了特征分析。对于每一种情况，都规定了所涉及的触发因素。除了我们的回顾性分析外，我们还对59例已发表的病例进行了全面的回顾，就触发因素在BP中的参与进行了分析，并收集了临床、流行病学和免疫学数据。在对9名诊断为BP的患者进行的当地研究中，确定了各种触发因素：造影剂注射、外科手术、机械创伤、昆虫叮咬、热烧伤、放疗和与既存银屑病相关的紫外线暴露。来自所有患者的自身抗体显示激活粒细胞并诱导真皮-表皮分裂。不同的假说涉及的触发因素的发病机制进行了讨论。就发病机制而言，我们认为最可靠的假设是BP患者已经具有低滴度的激活粒细胞的抗基底膜自身抗体。然而，触发因素干预的发病机制还需要更多的研究来更好地理解。
Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease affecting mainly the elderly. The subtype of the disease induced by physical agents represents a rare and, therefore, insufficiently characterized form. In the present study, we aimed to contribute to a better understanding of the pathogenetic mechanisms involved in the onset of BP induced by different trigger factors. We have retrospectively analyzed nine cases of BP. All patients were characterized based on clinical, epidemiological and immunological parameters. For each case, the trigger factor involved was specified. In addition to our retrospective analysis, a comprehensive review of the 59 published cases was conducted, regarding the involvement of trigger factor in BP, and clinical, epidemiological and immunological data were collected. In the local study, conducted on nine patients diagnosed with BP, various trigger factors were identified: contrast substance injection, surgical procedure, mechanical trauma, insect bite, thermal burn, radiotherapy and ultraviolet exposure associated with pre-existing psoriasis. The autoantibodies from all patients were shown to activate granulocytes and induce dermal-epidermal split. Different hypotheses regarding the pathogenetic mechanism involving the trigger factors have been discussed. In regard of the pathogenetic mechanism, we believe that the most reliable hypothesis is that BP patients already have low titers of anti-basement membrane autoantibodies which activate the granulocytes. However, more studies are needed for a better understanding of the pathogenetic mechanism of the intervention of trigger factors.