天疱疮患者临床特征和Dsg1及Dsg3抗体结果分析

梁波; 高金平; 张书梅

doi:10.16766/j.cnki.issn.1674-4152.002578

天疱疮患者临床特征和Dsg1及Dsg3抗体结果分析

doi: 10.16766/j.cnki.issn.1674-4152.002578

安徽医科大学第一附属医院皮肤性病科，安徽合肥 230022

基金项目:

国家自然科学基金项目 82073438

安徽医科大学校科研基金项目 2020xkj154

详细信息

通讯作者:
张书梅, E-mail: 1053277184@qq.com

中图分类号: R753.1
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出版历程
- 收稿日期: 2021-07-18
- 网络出版日期: 2022-09-26

Analysis of clinical features and results of Dsg1 and Dsg3 antibodies in patients with pemphigus

Department of Dermatology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China

摘要

摘要: 目的研究天疱疮患者的临床特征，分析桥粒芯糖蛋白1抗体(desmoglein 1，Dsg1)和桥粒芯糖蛋白3抗体(desmoglein 3，Dsg3)ELISA检测结果与天疱疮分型及严重程度之间的关联。方法选取2021年1—12月安徽医科大学第一附属医院收治的50例天疱疮患者，根据临床表现、实验室指标对天疱疮进行分型和分级，对诱发因素、伴发疾病、皮肤感染情况、Dsg1及Dsg3抗体指数等进行回顾性分析。结果 50例天疱疮患者中寻常型天疱疮39例、红斑型天疱疮8例、落叶型天疱疮2例和副肿瘤性天疱疮1例；轻度28例，中度11例，重度11例；常见诱发因素和糖皮质激素不规范使用有关，占比20%(10/50)；最常见皮肤感染菌为金黄色葡萄球菌，检出率为18%(9/50)。不同类型天疱疮患者Dsg3抗体指数差异有统计学意义(Z=-3.481，P＜0.001)；不同严重程度天疱疮患者Dsg1及Dsg3抗体差异有统计学意义(P值分别为0.002、0.024)。结论天疱疮患者治疗中要注重糖皮质激素的正确使用，皮肤感染在天疱疮患者中较为常见，Dsg1及Dsg3抗体检测在天疱疮患者中具有较高的阳性率，Dsg1及Dsg3抗体指数可作为天疱疮病情评估的指标。
- 天疱疮 /
- 桥粒芯糖蛋白1抗体-ELISA /
- 桥粒芯糖蛋白3抗体-ELISA /
- 临床分析
Abstract: Objective Methods To investigate the clinical features of pemphigus patients and analyse the correlation between the results of ELISA test on desmoglein 1 (Dsg1) antibody and Desmoglein 3 (Dsg3) antibody and the type and severity of pemphigus. Methods Fifty patients with pemphigus were selected from the First Affiliated Hospital of Anhui Medical University in 2021. The patients were classified and graded based on clinical manifestation and laboratory indexes. Retrospective analysis was conducted on the inducing factors, complications, skin infection status and Dsg1 and Dsg3 antibody titres. Results A total of 39 cases of pemphigus vulgaris, 8 cases of pemphigus erythematous, 2 cases of pemphigus foliaceus and 1 case of paraneoplastic pemphigus were confirmed amongst these 50 patients. Amongst them, 28 cases were mild, 11 cases were medium and 11 cases were severe. One of the common inducing factors was found to be the non-standard use of glucocorticoid, accounting for 20% (10/50) of all cases. The most common skin infection-related bacterium was Staphylococcus aureus, which was detected in 18% (9/50) of all cases. Amongst different types of patients with pemphigus, significant differences in Dsg3 antibody indexes were found (Z=-3.481, P < 0.001). In addition, there was a significant difference between the groups in patients with varying severity (P=0.002, 0.024). Conclusion Proper use of glucocorticoids is required in the treatment of pemphigus. Skin infection was found to be common in patients with pemphigus. The detection of Dsg1 and Dsg3 antibodies shows good sensitivity for pemphigus diagnosis, and the titres of these two types of antibodies can be utilised as indicators for the evaluation of pemphigus.
- Pemphigus /
- Desmoglein 1-ELISA /
- Desmoglein 3-ELISA /
- Clinical analysis

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图 1 1例男性天疱疮患者的皮肤影像学检查

注：A示糜烂干涸水疱在皮肤镜下可见白色条纹、粉红色区域、点状出血、污斑，且可见白色鳞屑呈环状分布(×20)；B示皮肤共聚焦显微镜下可见棘层内水疱，疱内可见松解细胞和内炎细胞集聚。

Figure 1. Skin imaging of a male patient with pemphigus

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表 1 不同类型天疱疮患者中Dsg1、Dsg3抗体指数检测分析[M(P₂₅, P₇₅), U/mL]

Table 1. Detection and analysis of Dsg1 and Dsg3 antibody index in patients with different types of pemphigus[M(P₂₅, P₇₅), U/mL]

类型	例数	Dsg1抗体指数	Dsg3抗体指数
寻常型天疱疮	39	57.50(13.75，155.75)	98.00(8.00，165.00)
红斑型天疱疮	8	105.50(88.00，211.50)	3.00(2.00，6.00)
Z值		-1.766	-3.481
P值		0.077	＜0.001
注：落叶型天疱疮和副肿瘤性天疱疮因为例数较少，未纳入统计学分析。

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表 2 不同严重程度天疱疮患者中Dsg1、Dsg3抗体指数检测分析[M(P₂₅, P₇₅), U/mL]

Table 2. Detection and analysis of Dsg1 and Dsg3 antibody index in pemphigus patients with different severity[M(P₂₅, P₇₅), U/mL]

严重程度	例数	Dsg1抗体指数	Dsg3抗体指数
轻度	28	25.00(6.00，95.00)	8.50(2.00，115.00)
中度	11	100.00(53.50，263.00)^a	85.00(6.50，177.25)^a
重度	11	181.00(142.00，219.25)^ab	160.50(46.75，190.25)^ab
χ²值		12.498	7.459
P值		0.002	0.024
注：与轻度组比较，^aP＜0.05；与中度组比较，^bP＜0.05。

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