抗表皮棘细胞桥粒抗体、抗桥粒芯糖蛋白1、3抗体（Dsg1、Dsg3）在天疱疮中的诊断价值

摘要

Objective To analyze and evaluate the value of the anti-epidermal intercellular desmosome anti-body as well as Dsg1 and Dsg3 in the diagnosis for emphigus.Methods Patients were divided into the ex-perimental group and the control group.The experimental group was diagnosed as pemphigus patients con-firmed by clinical,histopathological and indirect immunofluorescence.The control group has been ruled out of pemphigus.IIF (Indirect Immunofluorescence)was used to detect resistance to epidermal intercellu-lar desmosome antibodies.Enzyme Linked Immunosorbent Assay (ELISA)was used to detect Dsg1 and Dsg3,counting the sensitivity,specificity,negative predictive value and positive predictive value of each antibody,evaluating comprehensively and analyzing the combination of the statistics and the clinical data. Results In the test group and control group,the positive rates of anti-epidermal intercellular desmosome antibody are respectively 73.5% (25/34)and 2.8% (1/36).While the positive rates of anti Dsg1 antibody are respectively 70.6% (24/34)and 0.0% (0/36).The positive rates of anti Dsg3 antibody are respectively 79.4% (27/34)and 5.6% (2/36).Among the patients with pemphigus,the sensitivity of anti-epidermal desmosomes prickle cell antibody test,specificity,positive predictive value (PPV),negative predictive value (NPV),diagnosis rates were 73.5%,97.2%,96.2%,79.5%,85.7%.Dsg1,respectively,70.6%, 100.0%,100.0%,78.3%,85.7%.Dsg3 were 79.4%,94.4%,93.1%,82.9%,87.1%.There was no sig-nificant difference between IIF and Dsg1,3 (P >0.05).Conclusion The antibody detection in blood circu-lation and the confirmation test of the specific target antigens could complement each other,reduce the clinical misdiagnosis and increase the diagnostic positive rate if the two tests were conducted at the same time.The positive result of anti-pemphigus antibody was good at diagnosing pemphigus accurately,while the negative result is of great value to rule out pemphigus.%目的：分析评价抗表皮棘细胞桥粒抗体、抗桥粒芯糖蛋白1、3抗体（Dsg1、Dsg3）在天疱疮中的诊断价值。方法选择2011年2月-2013年2月在新疆医科大学第一附属医院皮肤科诊治经临床、组织病理及间接免疫荧光确诊为天疱疮的34例患者（试验组），选择同期排除天疱疮的36例患者为对照组。采用间接免疫荧光法（IIF）检测抗表皮棘细胞桥粒抗体，采用酶联免疫吸附法（ELISA）检测 Dsg1、Dsg3；统计各检测指标的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和诊断符合率。结果试验组和对照组抗表皮棘细胞桥粒抗体的阳性率分别为73．5％（25/34）、2．8％（1/36）。Dsg1抗体阳性率分别为70．6％（24/34）、0．0％（0/36），Dsg3抗体阳性率分别为79．4％（27/34）、5．6％（2/36）。在天疱疮患者中，抗表皮棘细胞桥粒抗体试验的敏感度、特异度、PPV、NPV、诊断符合率分别为73．5％、97．2％、96．2％、79．5％、85．7％，Dsg1分别为70．6％、100．0％、100．0％、78．3％、85．7％，Dsg3分别为79．4％、94．4％、93．1％、82．9％、87．1％。3种指标在天疱疮患者中灵敏度和特异度的差异无统计学意义（P＞0．05）。结论同时行血中循环抗体检测与具体靶抗原确认试验检测，能互相补充，减少临床漏诊，提高诊断阳性率。抗天疱疮抗体阳性结果对确诊天疱疮准确性较好，阴性者排除天疱疮的价值较大。