[1]李秀秀,吴楠,杜文辉,等.天疱疮患者273例组织病理和免疫病理分析[J].中国皮肤性病学杂志,2021,(01):110-5df15dff-14df-4960-8b88-e2de08101f57/pdf.[doi:10.13735/j.cjdv.1001-7089.202006070]
 LI Xiuxiu,WU Nan,DU Wenhui,et al.Study on Histopathological and Immunopathological Findings in 273 Cases of Patients with Pemphigus[J].The Chinese Journal of Dermatovenereology,2021,(01):110-5df15dff-14df-4960-8b88-e2de08101f57/pdf.[doi:10.13735/j.cjdv.1001-7089.202006070]
点击复制

天疱疮患者273例组织病理和免疫病理分析
分享到:

《中国皮肤性病学杂志》[ISSN:1001-7089/CN:61-1197/R]

卷:
期数:
2021年01期
页码:
110-5df15dff-14df-4960-8b88-e2de08101f57/pdf
栏目:
检验技术
出版日期:
2021-01-01

文章信息/Info

Title:
Study on Histopathological and Immunopathological Findings in 273 Cases of Patients with Pemphigus
文章编号:
1001-7089(2021)01-0110-06
作者:
李秀秀吴楠杜文辉张书梅王培光
安徽医科大学第一附属医院皮肤性病科,安徽合肥230022
Author(s):
LI XiuxiuWU NanDU WenhuiZHANG ShumeiWANG Peiguang
Department of Dermatology and Venerology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China
关键词:
天疱疮 寻常型天疱疮 组织病理 免疫病理
Keywords:
Pemphigus Pemphigus vulgaris Histopathology Immunopathology
分类号:
R 758.66
DOI:
10.13735/j.cjdv.1001-7089.202006070
文献标志码:
B
摘要:
目的 分析组织病理、DIF、IIF和ELISA四种实验室检测方法在天疱疮患者诊断中的临床意义。方法 回顾性分析273例天疱疮住院患者的组织病理、DIF、IIF、抗Dsg1和抗Dsg3抗体的检查结果。结果 组织病理检查显示,186例(82.30%,186/226)表现为表皮内水疱形成或细胞松解; DIF检查显示,170例(80.19%,170/212)结果阳性,其中7例仅出现皮肤基底膜带C3线状沉积,伴有/不伴有IgG线状沉积; IIF检查显示,77例(69.37%,77/111)检查结果呈现阳性; 抗Dsg1和抗Dsg3抗体检测显示,126例(95.45%,126/132)出现抗Dsg1抗体和/或抗Dsg3抗体阳性。寻常型及增殖型天疱疮抗Dsg3抗体阳性率(89.53%)明显高于红斑型及落叶型(25.64%),差异有统计学意义(P=0.000); 伴有/仅有黏膜损害的天疱疮患者抗Dsg3抗体阳性率(89.04%)亦显著高于仅有皮肤损害的天疱疮患者(38.18%),差异有统计学意义(P=0.000)。结论 在天疱疮四种实验室诊断方法中,抗Dsg1和抗Dsg3抗体检测的阳性率最高。四种检查方法联合应用有助于天疱疮的正确诊断。
Abstract:
Objective To analyze the clinical significance of four laboratory methods including histopathology,direct immunofluorescence(DIF),indirect immunofluorescence(IIF)and enzyme-linked immuno-sorbent assay(ELISA)in the diagnosis of patients with pemphigus. Methods We retrospectively analyze the findings of histopathology,DIF,IIF and ELISA in 273 cases of patients with pemphigus. Results The histopathological examination revealed that acantholysis or formation of blister in the epidermis was present in 186 cases(82.30%,186/226). DIF examination showed positive results in 170 cases(80.19%,170/212)of patients. Only deposition of C3 along the basement membrane zone with/without IgG was observed in 7 of 170 cases. IIF examination showed that 77 cases(69.37%,77/111)of patients had circulating antibodies directing against intercellular components of epidermis or mucosal epithelium. ELISA showed positive anti-Dsg1 and/or anti-Dsg3 antibodies in 126 cases(95.45%,126/132)cases. The positive rate of anti-Dsg3 antibodies in pemphigus vulgaris and pemphigus vegetans was significantly higher than that in pemphigus erythematosus and pemphigus foliaceus(89.53% vs. 25.64%)(P=0.000). The positive rate of anti-Dsg3 antibodies in pemphigus associated with/only with the involvement of mucosa was higher than that in pemphigus with only involvement of skin(89.04% vs. 38.18%)(P=0.000).Conclusion The positive rate of anti-desmoglein 1 and 3 antibodies by ELISA is highest in four laboratory methods for diagnosing pemphigus. The combined utilization of these four methods can help us make an accurate diagnosis of pemphigus.

参考文献/References:

[1] Kuten-Shorrer M,Menon RS,Lerman MA. Mucocutaneous diseases[J].Dent Clin North Am,2020,64(1):139-162.
[2] 张学军,涂平.皮肤性病学[M].北京:人民卫生出版社,2014:277.
[3] 寻常型天疱疮诊断和治疗专家建议(2020)[J].中华皮肤科杂志,2020,53(1):1-7.
[4] Kasperkiewicz M,Ellebrecht CT,Takahashi H,et al.Pemphigus[J].Nat Rev Dis Primers,2017,3:17026.
[5] Kridin K,Patel PM,Jones VA,et al.IgA pemphigus:A systematic review[J].J Am Acad Dermatol,2020,82(6):1386-1392.
[6] 杜文辉,李卉,王培光,等.天疱疮与大疱性类天疱疮患者3种实验检测结果比较[J].安徽医学,2017,38(9):1164-1166.
[7] Diercks GF,Pas HH,Jonkman MF. Immunofluorescence of autoimmune bullous diseases[J].Surg Pathol Clin,2017,10(2):505-512.
[8] 刘玮,曾志良,马玲,等.自身免疫性大疱性皮肤病患者免疫学检测结果分析[J].实验与检验医学,2019,37(1):136-138.
[9] 高涛,龙娟,吕静,等.大疱性类天疱疮227例回顾性临床分析[J].临床皮肤科杂志,2019,48(1):6-9.
[10] Yeoh SC,Byth-Wilson K,Murrell DF,et al.Pemphigus vulgaris disease activity:The role of antibodies to desmogleins and their isotype[J].J Oral Pathol Med,2019,48(7):619-625.
[11] Altun E,Yayl S,Selçuk LB,et al.Clinical and demographic characteristics of pemphigus vulgaris patients[J].Acta Dermatovenerol Croat,2018,26(2):119-125.
[12] Melchionda V,Harman KE. Pemphigus vulgaris and pemphigus foliaceus:an overview of the clinical presentation,investigations and management[J].Clin Exp Dermatol,2019,44(7):740-746.
[13] 周小芳,宋志强,邓向芬,等.血清抗桥粒芯蛋白1和3抗体在天疱疮临床诊断中的意义[J].实用皮肤病学杂志,2019,12(2):82-83,86.
[14] Hrabovska Z,Jautova J,Hrabovsky V. A study of clinical,histopathological and direct immunofluorescence diagnosis in pemphigus group Utility of direct immunofluorescence[J].Bratisl Lek Listy,2017,118(4):243-249.

相似文献/References:

[1]蒋冠,黄小凤,庞雁宇,等.夫西地酸联合糠酸莫米松治疗慢性家族性良性天疱疮22例临床观察[J].中国皮肤性病学杂志,2017,(11):1281.[doi:10.13735/j.cjdv.1001-7089.201701001]
 JIANG Guan,HUANG Xiao-feng,PANG Yan-yu,et al.Clinical Observation of Fusidic Acid Cream Therapy Combined with Mometasone Furoate Cream for Hailey-Hailey Disease[J].The Chinese Journal of Dermatovenereology,2017,(01):1281.[doi:10.13735/j.cjdv.1001-7089.201701001]
[2]刘琼,许贵霞,张思平.天疱疮患者感染危险因素分析[J].中国皮肤性病学杂志,2019,(07):788.[doi:10.13735/j.cjdv.1001-7089.201809116]
 LIU Qiong,XU Guixia,ZHANG Siping.Risk Factors for Infection in Patients with Pemphigus[J].The Chinese Journal of Dermatovenereology,2019,(01):788.[doi:10.13735/j.cjdv.1001-7089.201809116]
[3]张雪彤,潘萌.硫唑嘌呤的药物基因型及其在天疱疮治疗中的作用[J].中国皮肤性病学杂志,2020,(05):596.[doi:10.13735/j.cjdv.1001-7089.201905004]
 ZHANG Xuetong,PAN Meng.Genotypes of Azathioprine and its Role in the Treatment of Pemphigus[J].The Chinese Journal of Dermatovenereology,2020,(01):596.[doi:10.13735/j.cjdv.1001-7089.201905004]
[4]胡凤侠,梁俊琴,毛丽旦,等.Neumann型增殖型天疱疮7例临床分析[J].中国皮肤性病学杂志,2021,(01):48.[doi:10.13735/j.cjdv.1001-7089.202005183]
 HU Fengxia,LIANG Junqin,MAO Lidan,et al.Clinical Analysis of 7 Cases of the Neumann Type of Pemphigus Vegetans[J].The Chinese Journal of Dermatovenereology,2021,(01):48.[doi:10.13735/j.cjdv.1001-7089.202005183]

备注/Memo

备注/Memo:
[通信作者] 王培光,E-mail:wpg2370@163.com
更新日期/Last Update: 2021-01-10