应用酶联免疫吸附试验检测血清桥粒芯蛋白抗体水平监测寻常型天疱疮患者病情变化

Detection of serum desmoglein antibody level using enzyme-linked immunosorbent assay(ELISA) for monitoring disease activity in patients with pemphigus vulgaris

目的:研究较大样本寻常型天疱疮(pemphigus vulgaris,PV)患者,血清抗桥粒芯蛋白(desmoglein,Dsg)1和抗Dsg3特异性抗体酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)指数长期的变化情况,观察其与病情变化的相关性,探讨其用于病情监测、预测疾病复发和指导治疗的可行性。方法:对20例确诊PV的患者进行长期随访,收集患者在各随访时间点的血清,记录每次随访时的病情并进行评分(autoimmune bullous skin disorderintensity score,ABSIS);检测患者血清的间接免疫荧光(indirect immunofluorescence,IIF)滴度、Dsg3 ELISA指数和Dsg1 ELISA指数;利用统计学方法和做图方法分析病情评分与Dsg3 ELISA指数、Dsg1 ELISA指数和IIF滴度之间的关系。结果:PV患者皮肤和口腔的病情评分,分别与Dsg3 ELISA指数、Dsg1 ELISA指数和IIF滴度均具有显著性关联(P<0.01),患者疾病活动期和临床缓解期两组间Dsg3 ELISA指数、Dsg1 ELISA指数和IIF滴度差异均有统计学意义(P<0.01)。各组患者相关性分析发现,Dsg3 ELISA指数、Dsg1 ELISA指数和IIF滴度几乎均与病情平行波动变化,ELISA指数优于IIF的平行性,并且ELISA指数可以预测病情是否会反复,从而指导治疗。结论:PV患者血清抗Dsg3抗体ELISA指数与病情变化平行波动,可以反映疾病的活动程度,可用于病情监测,并可为临床上预测疾病复发,指导临床调整治疗提供有利的实验室证据。

Objective：Pemphigus is an autoimmune blistering disease of skin and mucous membranes.Pemphigus vulgaris（PV） is a major subtype of pemphigus,which is histologically characterized by suprabasal acantholysis.The major antigen in PV is desmosomal glycoproteins desmoglein（Dsg） 3.The autoantibodies against Dsg3 cause loss of adhesion between keratinocytes.Some PV patients also have circulating anti-Dsg1 autoantibodies.Enzyme-linked immunosorbent assays（ELISAs） with recombinant Dsg3 and Dsg1 are highly sensitive and specific for detecting anti-Dsg3 and anti-Dsg1 autoantibodies in PV patients.To evaluate the role of desmosomal glycoproteins desmoglein（Dsg3） ELISA and Dsg1 ELISA for detecting anti-Dsg3 and anti-Dsg1 autoantibodies in monitoring disease activity in Pemphigus vulgaris patients.Methods：Twenty PV patients with long-term follow-up were included.We tested their serial sera with modified Dsg3 ELISA（MESACUP Desmoglein TEST ＂Dsg3＂,Medical ＆ Biological Laboratories Co.LTD.）,Dsg1 ELISA（MESACUP Desmoglein TEST ＂Dsg1＂,Medical ＆ Biological Laboratories Co.LTD.） and indirect immunofluorescence（IIF）.Then we analyzed the correlation between Dsg3 ELISA index values,Dsg1 ELISA index values,IIF titres and disease activity scores（ABSIS） along the time course.Results：There were significant correlations between Dsg3 ELISA index values,Dsg1 ELISA index values,IIF titres and disease activity scores（both skin scores and oral scores）（P〈0.01） along the time course.Significant differences of Dsg3 ELISA index values,Dsg1 ELISA index values and IIF titres between active time-point group and clinical remission time-point group were also observed（P〈0.01）.We found that Dsg3 ELISA index values,Dsg1 ELISA index values and IIF titres fluctuated in parallel with disease activity,and ELISA index values were superior to IIF titres.Conclusion：Dsg3 ELISA index values fluctuating in parallel with disease activity are useful to monitor disease activity,predict flares or relapses and plan the schedules for tapering the drugs.