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
计量
- 文章访问数: 231
- HTML全文浏览量: 357
- PDF下载量: 19
- 被引次数: 0
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

HTML全文

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

下载: 全尺寸图片幻灯片

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。

下载: 导出CSV

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。

下载: 导出CSV

参考文献(21)

[1]	SHARMA V K, PRASAD H R, KHANDPUR S, et al. Evaluation of desmoglein enzyme-linked immunosorbent assay (ELISA) in Indian patients with pemphigus vulgaris[J]. Int J Dermatol, 2006, 45(5): 518-522. doi: 10.1111/j.1365-4632.2006.02593.x
[2]	章若锦, 胡领, 陈蕾蕾, 等. 基于症状日记的健康教育模式对天疱疮患者心理健康及知信行的影响[J]. 中国基层医药, 2021, 28(10): 1579-1581. doi: 10.3760/cma.issn1008-6706.2021.10.031 ZANG R J, HU L, CHEN L L, et al. Effects of symptom diary-based health education on mental health and knowledge, attitude, practice of patients with pemphigus[J]. Chinese Journal of Primary Medicine and Pharmacy, 2021, 28(10): 1579-1581. doi: 10.3760/cma.issn1008-6706.2021.10.031
[3]	马海芬, 申艳, 罗丹, 等. 疑似白塞病的副肿瘤天疱疮临床特征分析[J]. 中国临床医学, 2021, 28(4): 705-709. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX202104035.htm MA H F, SHEN L, LUO D, et al. Clinical characteristics of paraneoplastic pemphigus suspected of Behcet disease[J]. Chinese Journal Of Clinical Medicine, 2021, 28(4): 705-709. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX202104035.htm
[4]	凯迪丽亚·艾米拉江, 帕丽达·阿布利孜. 天疱疮发病机制研究进展[J]. 临床皮肤科杂志, 2021, 50(4): 244-247. https://www.cnki.com.cn/Article/CJFDTOTAL-LCPF202104015.htm KEDELIA AMILAGHAN, PARIDA ABULIZI. Advances in pathogenesis of pemphigus[J]. Journal of Clinical Dermatology, 2021, 50(4): 244-247. https://www.cnki.com.cn/Article/CJFDTOTAL-LCPF202104015.htm
[5]	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, 35(1): 110-115. https://www.cnki.com.cn/Article/CJFDTOTAL-ZBFX202101026.htm LI X X, WU N, DU W H, et al. Study on histopathological and immunopathological findings in 273 cases of patients with pemphigus[J]. The Chinese Journal of Dermatovenereology, 2021, 35(1): 110-115. https://www.cnki.com.cn/Article/CJFDTOTAL-ZBFX202101026.htm
[6]	李惠, 林麟, 张洁尘, 等. 不同亚型天疱疮患者血清对HaCaT细胞桥粒芯糖蛋白3表达的影响[J]. 中国麻风皮肤病杂志, 2015, 31(3): 131-135. https://www.cnki.com.cn/Article/CJFDTOTAL-MALA201503002.htm LI H, LIN L, ZHANG J C, et al. Effects of serum from different subtypes of pemphigus on the expression of desmoglein-3 in HaCaT cells[J]. China Journal of Leprosy and Skin Diseases, 2015, 31(3): 131-135. https://www.cnki.com.cn/Article/CJFDTOTAL-MALA201503002.htm
[7]	董婧, 曹俊, 周小勇. 误诊为白塞病的寻常型天疱疮1例[J]. 中国麻风皮肤病杂志, 2013, 29(6): 423-424. doi: 10.3969/j.issn.1009-1157.2013.06.036 DONG J, CAO J, ZHOU X Y. A case of pemphigus vulgaris misdiagnosed as Behcet' s disease[J]. China Journal of Leprosy and Skin Diseases, 2013, 29(6): 423-424. doi: 10.3969/j.issn.1009-1157.2013.06.036
[8]	楼小航, 刘继峰, 吴纪龙, 等. 102例天疱疮患者合并感染临床分析[J]. 中华全科医学, 2016, 14(4): 563-565. doi: 10.16766/j.cnki.issn.1674-4152.2016.04.016 LOU X H, LIU J F, WU J L, et al. Clinical Analysis of 102 cases of pemphigus with infection[J]. Chinese Journal of General Practice, 2016, 14(4): 563-565. doi: 10.16766/j.cnki.issn.1674-4152.2016.04.016
[9]	周夕湲, 赵蓓, 陈学军, 等. 151例天疱疮患者并发感染的回顾性研究[J]. 实用皮肤病学杂志, 2017, 10(1): 12-14. https://www.cnki.com.cn/Article/CJFDTOTAL-SYPF201701006.htm ZHOU X Y, ZHAO P, CHEN X J, et al. Retrospective study on 151 cases of pemphigus complicated with infections[J]. Journal of Practical Dermatology, 2017, 10(1): 12-14. https://www.cnki.com.cn/Article/CJFDTOTAL-SYPF201701006.htm
[10]	李丽莉, 孙秀坤, 沈宏. 基于16S rDNA序列分析天疱疮患者皮肤菌群的变化[J]. 中华皮肤科杂志, 2021, 54(3): 212-219. https://www.cnki.com.cn/Article/CJFDTOTAL-HJKZ202111040.htm LI L L, SUN X K, SHEN H. Analysis of skin microbiota diversity in patients with pemphigus based on 16S rDNA sequences[J]. Chinese Journal of Dermatology, 2021, 54(3): 212-219. https://www.cnki.com.cn/Article/CJFDTOTAL-HJKZ202111040.htm
[11]	吴淑萍, 吴华娟, 郝淑青, 等. 重症寻常型天疱疮严重皮肤感染的病原学分析及抗菌药物治疗[J]. 医药论坛杂志, 2014, 35(7): 24-26. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYX201407011.htm WU S P, WU H J, HAO S Q. Etiological analysis of severe pemphigus vulgaris patients with severe skin infections and antibiotic therapy[J]. Journal of Medical Forum, 2014, 35(7): 24-26. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYX201407011.htm
[12]	李云珍, 李玲, 刘勇, 等. 血清中4种天疱疮抗体在天疱疮诊断及鉴别诊断中的价值[J]. 检验医学与临床, 2021, 18(10): 1398-1400. https://www.cnki.com.cn/Article/CJFDTOTAL-JYYL202110015.htm LI Y Z, LI L, LIU Y, et al. The role of four serum pemphigus antibodies in the diagnosis and differentiation of pemphigus[J]. Laboratory Medicine and Clinic, 2021, 18(10): 1398-1400. https://www.cnki.com.cn/Article/CJFDTOTAL-JYYL202110015.htm
[13]	李锁, 李志量, 荆可, 等. 桥粒芯糖蛋白抗体与天疱疮临床表型和疾病活动度的关系及其变化规律[J]. 中华皮肤科杂志, 2019, 52(5): 297-301. LI S, LI Z L, KE K, et al. Associations of anti-desmoglein antibodies with clinical phenotypes and disease activity in pemphigus patients and their change patterns[J]. Chinese Journal of Dermatology, 2019, 52(5): 297-301.
[14]	沈佳, 元慧杰, 潘萌. 大疱性类天疱疮患者外用糖皮质激素治疗抵抗的相关因素分析[J]. 临床皮肤科杂志, 2020, 49(3): 5. https://www.cnki.com.cn/Article/CJFDTOTAL-LCPF202003005.htm SHEN J, YUAN H J, PAN M. Analysis of the factors related to glucocorticoid-resistance in bullous pemphigoid patients[J]. Journal of Clinical Dermatology, 2020, 49(3): 5. https://www.cnki.com.cn/Article/CJFDTOTAL-LCPF202003005.htm
[15]	RUSSO I, DE SIENA F P, SAPONERI A, et al. Evaluation of anti-desmoglein-1 and anti-desmoglein-3 autoantibody titers in pemphigus patients at the time of the initial diagnosis and after clinical remission[J]. Medicine (Baltimore), 2017, 96(46): e8801. DOI: 10.1097/MD.0000000000008801.
[16]	柯丹, 杜宇, 邓抒琴, 等. 天疱疮患者抗桥粒芯糖蛋白与疾病相关性分析[J]. 重庆医学, 2016, 45(18): 2498-2499, 2503. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX201618015.htm KE D, DU Y, DENG S Q, et al. Analysis on relationship between serum anti-desmoglein antibodies and disease in patients with pemphigus[J]. Chongqing Medicine, 2016, 45(18): 2498-2499, 2503. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX201618015.htm
[17]	HARMAN K E, SEED P T, GRATIAN M, et al. The severity of cutaneous and oral pemphigus is related to desmoglein 1 and 3 antibody levels[J]. Br J Dermatol, 2001, 144(4): 775-780.
[18]	陈娅苑, 朱海琴, 潘萌, 等. 副肿瘤性天疱疮抗Dsg1和抗Dsg3抗体滴度及亚型和细胞因子的表达[J]. 中国皮肤性病学杂志, 2011, 25(3): 167-170. https://www.cnki.com.cn/Article/CJFDTOTAL-ZBFX201103003.htm CHEN Y Y, ZHU H Q, PAN M, et al. The study on anti-Dsg1, Dsg3 antibody subclass production and cytokines expression in the patients with paraneoplastic pemphigus[J]. The Chinese Journal of Dermatovenereology, 2011, 25(3): 167-170. https://www.cnki.com.cn/Article/CJFDTOTAL-ZBFX201103003.htm
[19]	张国学, 王俊秀, 樊翌明, 等. 寻常型天疱疮患者血清、唾液Dsg1、3抗体的检测及其临床意义[J]. 广东医学院学报, 2011, 29(4): 419-421. https://www.cnki.com.cn/Article/CJFDTOTAL-GDYY201104030.htm ZHANG G X, WANG J X, FAN Y M, et al. Detection of Dsg1 and 3 antibodies in serum and saliva of patients with pemphigus vulgaris and its clinical significance[J]. Journal of Guangdong Medical College, 2011, 29(4): 419-421. https://www.cnki.com.cn/Article/CJFDTOTAL-GDYY201104030.htm
[20]	凯迪丽亚·艾米拉江. 115例天疱疮和81例大疱性类天疱疮回顾性分析[D]. 乌鲁木齐: 新疆医科大学, 2019. KEDELIA AMILAGHAN. Retrospective analysis of 115 cases of pemphigus and 81 cases of bullous pemphigoid[D]. Urumqi: Xinjiang Medical University, 2019.
[21]	高岩. 天疱疮患者血清抗桥粒芯糖蛋白抗体与疾病临床特征的相关性研究[J]. 现代医学, 2014, 42(6): 648-651. https://www.cnki.com.cn/Article/CJFDTOTAL-TDYX201406014.htm GAO Y. Research on relationship between serum anti-desmoglein antibodies and disease clinical features in patients with pemphigus[J]. Modern Medical Journal, 2014, 42(6): 648-651. https://www.cnki.com.cn/Article/CJFDTOTAL-TDYX201406014.htm