桥粒芯蛋白1酶联免疫吸附试验检测落叶型天疱疮血清抗体的评价

Evaluation of desmoglein 1 enzyme-linked immunosorbent assay in the detection of serum antibodies in patients with pemphigus foliaceus

目的 探讨桥粒芯蛋白1（Dsg1）酶联免疫吸附试验（ELISA）检测落叶型天疱疮（PF）血清学抗体的意义.方法 将80例PF患者和132例对照人群的血清标本进行编盲,用ELISA法检测所有标本中抗Dsg1自身抗体,同时应用间接免疫荧光（IIF）法检测所有标本的抗体滴度,操作过程为随机检测,最后将两方法的结果进行比较.结果 75例PF患者和5例对照人群（包括1例不确定值,大疱性类天疱疮、SLE、皮肌炎、湿疹及健康者各1例）Dsg1 ELISA为阳性,71例PF患者和0例对照人群IIF为阳性.Dsg1ELISA的敏感性为93.8%（95%可信区间0.85～0.98）,特异性为96.2%（95%可信区间0.91～0.99）.IIF的敏感性为88.8%（95%可信区间0.82～0.96）,特异性为100%（95%可信区间0.96～1.00）.两者相比,敏感性（P=0.289）和特异性（P=1.000）差异均无统计学意义.结论 Dsg1 ELISA是一种简便、敏感、特异的血清学检测方法,可作为诊断PF的一种辅助手段.

Objective To evaluate the performance of desmoglein （Dsg）1 enzyme-linked immunosorbent assay （ELISA） in the detection of serum antibodies in patients with pemphigus foliaceus （PF）. Methods Sera were obtained from 80 patients with PF and 132 human controls including 33 patients with bullous pemphigoid, 3 patients with linear IgA bullous dermatosis, 2 patients with acquired bullous epidermolysis, 20 patients with systemic lupus erythematosus （SLE）, etc, and subjected to a random and blind test by Dsg1 ELISA and indirect immunofluorescence （IIF） on monkey oesophagus. Results The Dsg1 ELISA was positive in 75 （93.8%） patients with PF and 5 （3.8%） human controls （including 1 case of bullous pemphigoid, 1 case of SLE, 1 case of dermatomyositis, 1 case of eczema and 1 normal human control with indeterminate value）, and IIF was positive in 71 （88.8%） patients with PF, but in none of the controls. The sensitivity and specificity was 93.8% （95% CI： 0.85 - 0.98） and 96.2% （95% CI： 0.91 - 0.99） respectively for Dsg1 ELISA in the serodiagnosis of PF, 88.8% （95% CI： 0.82 - 0.96） and 100% （95% CI： 0.96 - 1.00） respectively for IIF. There was no statistical difference in the sensitivities （P= 0.289） or specificities （P= 1.000） between the two test methods.Conclusions Dsg1 ELISA is a simple, sensitive and specific serological detection method, and can serve as an adjunct in the diagnosis of PF.