两种检测方法在寻常型天疱疮诊断中的作用

摘要

目的 研究桥粒芯糖蛋白-酶联免疫吸附测定(desmoglein enzyme-linked immunosorbent assay,Dsg-ELISA)法检测寻常型天疱疮(pemphigus vulgaris,PV)抗体在PV诊断中的作用,以期为临床提供参考.方法 用Dsg-ELISA、猴食道为底物的间接免疫荧光法(monkey oesphagus-indirectimmunofluoreseent assay,MO-IIF)检测44例PV患者和29例非天疱疮口腔黏膜病患者血清抗体,比较两种方法的灵敏度和特异度.通过Dsg-ELISA法检测Dsg-1,3抗体水平,研究抗体水平与皮肤口腔黏膜病损严重程度的关系.结果 Dsg-3-ELISA灵敏度89％( 39/44),特异度93％(27/29)；MO-IIF灵敏度93％ (41/44),特异度83％ (24/29),两种方法的灵敏度和特异度相比差异均无统计学意义(P＞0.05)；Dsg-3抗体水平与口腔黏膜病损严重程度呈正相关(P＜0.01),与皮肤病损严重程度无相关性(P＞0.05)；Dsg-1抗体水平与皮肤病损严重程度呈正相关(P＜0.01),与口腔黏膜病损严重程度无相关性(P＞0.05).结论 MO-IIF、Dsg-3-ELISA是PV敏感性和特异性高的诊断方法；Dsg-ELISA是PV血清学诊断的有效工具,也可以作为PV病情判断的工具.%Objective To investigate the effect of the enzyme-linked immunosorbent assay(ELISA) and indirect immunofluorescent(IIF) on the diagnosis and monitoring of the activity of pemphigus vulgaris (PV).Methods Serum antibody titers of 44 PV patients and 29 none-PV patients were detected by desmoglein(Dsg)-1,3-ELISA and monkey oesphagus-IIF (MO-IIF).The sensitivity and specificity of the ELISA and MO-IIF were compared in the diagnosis of pemphigus vulgaris.The correlation between serum level of anti-desmoglein antibodies and the disease severity was analyzed.Results The sensitivity of MO-IIF was 93％ (41/44) and the specificity was 83 ％ (24/29).The sensitivity of Dsg-3-ELISA was 89％ (39/44) and the specificity was 93％ (27/29).There was no significant difference between MO-IIF and Dsg-3-ELISA (P ＞ 0.05 ).Dsg-3 antibody levels showed positive correlation with oral disease severity (P ＜ 0.01 )and no correlation with skin disease severity in pemphigus vulgaris( P ＜0.05 ).Dsg-1 antibody levels showed positive correlation with skin disease severity ( P ＜ 0.01 ) and no correlation with oral disease severity in pemphigus vulgaris(P ＜ 0.05 ).Conclusions Dsg-3-ELISA and MO- Ⅱ F methods were highly sensitive and specific in the diagnosis of PV.Dsg-1,3-ELISA is the useful tool for the sero-diagnosis and monitoring of the activity of PV.