Department of Dermatology, The Second Affiliated Hospital, Xi'an Jiaotong University, 157 Xiwu Road, Xincheng District, Xi'an, 710004, Shaanxi Province, China.
Vanderbilt University School of Medicine, Nashville, TN, USA.
Sci Rep. 2021 Sep 7;11(1):17746. doi: 10.1038/s41598-021-97202-w.
Bullous pemphigoid (BP), the most frequent blistering dermatosis in the elderly, is associated with increased mortality. The severity of BP can be assessed by detecting the anti-BP180 immunoglobulin G (IgG) concentration, but the lab test is not available in many community clinics. BP patients are usually in a hypercoagulable state with increased levels of D-dimer and fibrin degradation products (FDPs). We aimed to evaluate the use of D-dimer and FDPs in assessing BP severity. We compared the levels of plasma D-dimer, plasma FDPs, eosinophil counts, eosinophil cationic protein, and serum anti-BP180 IgG concentration between 48 typical BP patients and 33 Herpes zoster (HZ) patients (control group). Correlational analyses were conducted to determine the relationships between the lab values and common BP severity markers. The plasma D-dimer and FDP levels were higher in BP patients than in HZ controls (D-dimer: 3297 ± 2517 µg/L vs. 569.70 ± 412.40 µg/L; FDP: 9.74 ± 5.88 mg/L vs. 2.02 ± 1.69 mg/L, respectively, P < 0.0001). Significant positive correlations were found between D-dimer/FDP levels and BP severity markers (i.e. anti-BP180 IgG concentration [D-dimer: r = 0.3928, P = 0.0058; FDP: r = 0.4379, P = 0.0019] and eosinophil counts [D-dimer: r = 0.3625, P = 0.0013; FDP: r = 0.2880, P = 0.0472]) in BP patients. We also found an association between FDP and urticaria/erythema lesions (r = 0.3016, P = 0.0372), but no other BPDAI components. In 19 BP patients with complete remission after systemic glucocorticoid treatment, D-dimer and FDP levels decreased post-therapy (D-dimer: 5559 ± 7492 µg/L vs. 1738 ± 1478 µg/L; P < 0.0001; FDP: 11.20 ± 5.88 mg/L vs. 5.13 ± 3.44 mg/L; P = 0.0003), whereas they did not in BP patients with treatment resistant. Plasma D-dimer and FDP are convenient markers to evaluate BP severity assistant on BPDAI and eosinophil counts. FDP is also helpful for inflammatory lesions in BP patients.
大疱性类天疱疮（BP）是老年人中最常见的水疱性皮肤病，与死亡率增加有关。BP 的严重程度可以通过检测抗 BP180 免疫球蛋白 G（IgG）浓度来评估，但许多社区诊所都没有该实验室检测。BP 患者通常处于高凝状态，D-二聚体和纤维蛋白降解产物（FDPs）水平升高。我们旨在评估 D-二聚体和 FDP 在评估 BP 严重程度中的作用。我们比较了 48 例典型 BP 患者和 33 例带状疱疹（HZ）患者（对照组）之间的血浆 D-二聚体、血浆 FDPs、嗜酸性粒细胞计数、嗜酸性粒细胞阳离子蛋白和血清抗 BP180 IgG 浓度。进行了相关分析以确定实验室值与常见 BP 严重程度标志物之间的关系。BP 患者的血浆 D-二聚体和 FDP 水平高于 HZ 对照组（D-二聚体：3297±2517μg/L 与 569.70±412.40μg/L；FDP：9.74±5.88mg/L 与 2.02±1.69mg/L，P<0.0001）。在 BP 患者中，D-二聚体/FDP 水平与 BP 严重程度标志物（即抗 BP180 IgG 浓度[D-二聚体：r=0.3928，P=0.0058；FDP：r=0.4379，P=0.0019]和嗜酸性粒细胞计数[D-二聚体：r=0.3625，P=0.0013；FDP：r=0.2880，P=0.0472]）之间存在显著正相关。在 19 例接受全身糖皮质激素治疗后完全缓解的 BP 患者中，D-二聚体和 FDP 水平在治疗后降低（D-二聚体：5559±7492μg/L 与 1738±1478μg/L；P<0.0001；FDP：11.20±5.88mg/L 与 5.13±3.44mg/L；P=0.0003），而治疗抵抗的 BP 患者则没有。血浆 D-二聚体和 FDP 是评估 BP 严重程度的便捷标志物，辅助 BPDAI 和嗜酸性粒细胞计数。FDP 对 BP 患者的炎症性病变也有帮助。
