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总结1例线状IgA大疱性皮病（LABD）患者的中西医诊疗过程。患者因“身起红斑、水疱1年”来诊，经组织病理学分析和直接免疫荧光检测诊断为LABD。本病属罕见自身免疫性表皮下大疱病，缺乏中医药治疗相关文献报道。文章围绕该病例不同阶段病机、治法治则及遣方用药的变化进行讨论，提出“禀赋不耐，伏湿潜藏，因加而发”的发病观，强调“伏湿蕴毒，脾肾两虚”为本病核心病机，前期应重视除湿解毒，后期应脾肾双补、调和阴阳。此外，还应考虑药毒致病及药物偏性对病情变化的影响。中西医结合治疗LABD具有改善症状、延缓复发、缩短西药疗程及减少西药不良反应等作用，相关理论体系尚需完善。
Abstract：This article summarizes the diagnosis and treatment process of traditional Chinese and Western medicine for a patient with linear IgA bullous dermatosis(LABD). The patient presented with “erythema and vesicles on the body for 1 year” and was diagnosed with LABD through histopathology and direct immunofluorescence. LABD is a rare autoimmune subepidermal blistering disease,and there is a lack of relevant literature on traditional Chinese medicine treatments. This article discusses the changes in pathogenesis,therapeutic principles,and prescription strategies at different stages of this case,proposing that “constitutional intolerance,submersion of dampness,and exacerbation due to additional factors” are the primary causes for the onset of LABD,with “latent dampness harboring toxins,as well as deficiency of both the spleen and the kidney” as the core pathogenesis. In the early stage of treatment,emphasis should be placed on eliminating dampness and detoxifying,while in the later stage of treatment,the focus should shift to tonifying both the spleen and the kidney,and harmonizing yin and yang. Additionally,the influence of drug toxicity on causing diseases and the effect of drugs on the changes in disease condition should also be considered. Integrated traditional Chinese and Western medicine in the treatment of LABD has the effects of relieving symptoms,delaying recurrence,shortening the course of Western medicine treatment,and reducing adverse reactions to Western medicine. However,the relevant theoretical system still needs improvement.
[1] BECKER M ,SCHUMACHER N ,SCHMIDT E ,et al.Evaluation and comparison of clinical and iLaboratory characteristics of patients with IgA epidermolysis bullosa acquisita,linear IgA bullous dermatosis,and IgG epidermolysis bullosa acquisita[J]. JAMA Dermatol,2021,157(8):917-923.
[2]梁俊琴.线状IgA大疱性皮病[J].皮肤科学通报，2021,38(3):237-241.
[3]奥多姆，詹姆斯，伯杰.安德鲁斯临床皮肤病学：中文翻译版[M].徐世正，主译.徐文严，主校.北京：科学出版社，2019:468-469.
[4]宋平平，杨宝琦.线状IgA大疱性皮病研究进展[J].中国麻风皮肤病杂志，2022,38(11):837-841.
[5]中华医学会皮肤性病学分会，中国医师协会皮肤科医师分会.自身免疫性表皮下大疱病诊疗共识（2022）[J].中华皮肤科杂志，2022,55(1):1-11.
[6] CAUX F,PATSATSI A,KARAKIOULAKI M,et al. S2k guidelines on diagnosis and treatment of linear IgA dermatosis initiated by the European Academy of Dermatology and Venereology[J]. J Eur Acad Dermatol Venereol,2024,38(6):1006-1023.
[7]孙勇虎，周桂芝，张福仁.氨苯砜治疗成人线状IgA大疱性皮病一例[J].中国麻风皮肤病杂志，2021,37(10):657-658.
[8]陈喜雪，朱学骏.线状IgA大疱皮病8例分析[C]//中国中西医结合学会皮肤性病专业委员会. 2002中国中西医结合皮肤性病学术会议论文汇编.北京：中国中西医结合学会皮肤性病专业委员会，2002:1.
[9]杨德刚，史玉玲.氨苯砜在皮肤科的应用进展[J].皮肤科学通报，2021(4):364-369.
[10] KNEISEL A,HERTL M. Autoimmune bullous skin diseases. part 2:diagnosis and therapy[J]. J Dtsch Dermatol Ges,2011,9(11):927-947.
[11]陆家睛，史玉玲.糖皮质激素在皮肤科的应用[J].皮肤科学通报，2021,38(4):304-311.
[12]李丹，栾淑贞，纪云清，等.大疱性皮肤病中医古籍文献整理分析[J].北京中医药，2021,40(1):87-89.
[13]伍景平，程宏斌，李煜，等.论中医学天疱疮病名[J].辽宁中医药大学学报，2014,16(11):71-73.
[14]肖敏，宋玮，沈涛，等.天疱疮源流考[J].四川中医，2021,39(4):28-30.
[15]陈正龙，方敏灵.中医对天疱疮的认识[J].光明中医，2016,31(20):3010-3012.
[16]汪机.外科理例[M].上海：商务印书馆，1957:189.
[17]张景岳.外科钤[M].北京：中国医药科技出版社，2017:128.
[18]勾金凤，陈明岭，余倩颖，等.理湿法在天疱疮治疗中的应用[J].光明中医，2010,25(11):1990-1991.
[19]娄卫海，曲剑华.赵炳南从湿论治天疱疮经验[J].北京中医药，2014,33(2):100-102.
[20]刘久利，杨慧敏，王萍，等.张志礼辨治天疱疮经验[J].北京中医药，2020,39(8):816-818.
[21]周冬梅，杨志波，陈维文.天疱疮中医诊疗指南[J].中医杂志，2017,58(1):86-90.
[22]裘庆元.温病秘本十四种：上册[M].北京：中国中医药出版社，2019:309.
[23]董芮，张益生，蔡洵，等.从伏湿辨治特应性皮炎思路探讨[J].河北中医，2024,46(5):849-852,857.
[24]张炬，李承贤，袁卫玲，等.从伏湿论治过敏性鼻炎[J].中医药学报，2021,49(7):68-71.
[25]张晨晨，唐树杰.伏邪理论与运气理论[J].中华中医药杂志，2021,36(5):2597-2600.
[26]吴谦.外科心法要诀[M].赵晓鱼，整理.北京：中国医药科技出版社，2012:28.
[27] COLLIER P M,WOJNAROWSKA F,WELSH K,et al.Adult linear IgA disease and chronic bullous disease of childhood:the association with human lymphocyte antigens Cw7,B8,DR3 and tumour necrosis factor influences disease expression[J]. Br J Dermatol,1999,141(5):867-875.
[28] MENEGHINI M,TAMBUR A R. HLA-DQ antibodies in alloimmunity,what makes them different?[J]. Curr Opin Organ Transplant,2023,28(5):333-339.
[29] KRISHNA C,CHIOU J,SAKAUE S,et al. The influence of HLA genetic variation on plasma protein expression[J]. Nat Commun,2024,15(1):6469.
[30]张子和.儒门事亲[M].邓铁涛，赖畴，整理.北京：人民卫生出版社，2005:65-69.
[31] LAMMER J,HEIN R,ROENNEBERG S,et al. Druginduced linear IgA bullous dermatosis:a case report and review of the literature[J]. Acta Derm Venereol,2019,99(6):508-515.
[32] CHANAL J,INGEN-HOUSZ-ORO S,ORTONNE N,et al.Linear IgA bullous dermatosis:comparison between the drug-induced and spontaneous forms[J]. Br J Dermatol,2013,169(5):1041-1048.
[33] D’ASTOLTO R,QUINTARELLI L,CORRàA,et al.Environmental factors in autoimmune bullous diseases with a focus on seasonality:new insights[J]. Dermatol Reports,2023,15(3):9641.
基本信息:
DOI：10.16295/j.cnki.0257-358x.2025.09.019
中图分类号:R249;R275.9
引用信息:
[1]陈佳祺,薛国华,郭晓阳,等.从伏湿分期论治线状IgA大疱性皮病个案报道[J].山东中医杂志,2025,44(09):1042-1046.DOI:10.16295/j.cnki.0257-358x.2025.09.019.
基金信息:
国家自然科学基金面上项目(编号：82274525)
2025-09-05
2025-09-05