Abstract: 【Abstract】 Objective To investigate differences in clinical characteristics between bullous pemphigoid （BP） patients with stroke and those without, and their relationship with the prognosis of stroke. Methods A retrospective analysis was performed on medical records of 330 BP inpatients in the First Affiliated Hospital of Zhengzhou University from September 2012 to April 2020. These patients were divided into BP + stroke （ST） group and BP - ST group according to whether they were accompanied by stroke, and clinical manifestations and relevant laboratory examination results were compared between the two groups. According to the stroke outcome score assessed by modified Rankin Scale （mRS）, patients in the BP + ST group were further divided into good-prognosis ST group （mRS ≤ 2 points） and poor-prognosis ST group （mRS > 2 points）, and subgroup analysis was conducted. Correlations between measurement data （such as age, disease course and laboratory examination results） and mRS scores were analyzed. Results In the BP - ST group （256 cases）, 151 were males and 105 were females, and their age ranged from 19 to 92 （66.8 ± 13.6） years; in the BP + ST group （74 cases）, 45 were males and 29 were females, and their age ranged from 48 to 92 （74.6 ± 9.6） years; Compared with the BP - ST group, the BP + ST group showed older age （t = -5.57, P < 0.001）, shorter disease course of BP （Z = -3.07, P = 0.002）, and higher anti-BP180 IgG antibody levels （215.0 ［157.2, 283.1］ U/ml vs. 155.0 ［63.9, 279.8］ U/ml; Z = -2.12, P = 0.034）. The distribution of skin lesions significantly differed between the two groups （χ2 = 10.51, P = 0.015）, and the BP + ST group showed a significantly lower proportion of patients with generalized lesions（P＜0.05）, but a higher proportion of patients with lesions on the limbs （P＜0.05）. Subgroup analysis showed significant differences in the patients′ age, BP course, lesion distribution and anti-BP180 IgG antibody levels among the good-prognosis ST group, poor-prognosis ST group and BP - ST group （F = 10.83, P＜0.001; Z = 17.24, P＜0.001; χ2 = 15.57, P = 0.026; Z = 6.29, P = 0.043, respectively）. There was no significant difference in the age between the good-prognosis ST group and poor-prognosis ST group （adjusted P = 1.000）, but the patients were significantly older in the two above groups than in the BP - ST group （adjusted P = 0.001, 0.007, respectively）; the poor-prognosis ST group showed significantly shorter BP course （adjusted P = 0.016, < 0.001, respectively） and a higher proportion of patients with lesions on the limbs （both P < 0.05） compared with the good-prognosis ST group and BP - ST group, and significantly higher serum anti-BP180 IgG antibody levels compared with the BP - ST group （226.2 ［163.6, 285.8］ U/ml vs. 155.0 ［63.9，279.8］ U/ml; adjusted P = 0.037）. There were no significant differences in the gender distribution, lesional morphology, percentages and counts of peripheral blood eosinophils, serum total IgE levels, and anti-BP230 IgG antibody levels between the BP + ST group and BP - ST group （all P > 0.05）, or among the good-prognosis ST group, poor-prognosis ST group and BP - ST group （all P > 0.05）. Correlation analysis in the BP + ST group showed a significantly negative correlation between the BP course and mRS scores （r = -0.33, P = 0.004）, and a significantly positive correlation between the anti-BP180 IgG antibody levels and mRS scores （r = 0.34, P = 0.032）. Conclusion There were differences in the patients′ age, BP course, lesion distribution, and anti-BP180 IgG antibody levels between the BP patients with stroke and those without, and the differences were more obvious between the poor-prognosis ST group and BP - ST group.

Key words: Pemphigoid, bullous, Stroke, Nervous system disease, Prognosis, Autoantibodies, BP180 antigen, BP230 antigen