71例天疱疮的棘层松解位置分析

Locations of acantholysis in 71 cases of pemphigus

目的 探讨天疱疮的棘层松解位置，为天疱疮出现不同位置棘层松解的表现提供解释。方法 收集43例寻常型天疱疮和28例落叶型天疱疮患者的临床资料、组织病理、免疫病理、天疱疮抗体指标值进行分析。结果 寻常型天疱疮中有35例棘层松解的位置发生在基底层上方，8例发生在表皮中上部，落叶型天疱疮中有25例棘层松解的位置发生在颗粒层、棘层上方，3例发生在表皮中下部，落叶型天疱疮患者抗Dsg1抗体指标较寻常型天疱疮患者显著升高（P = 0.047），寻常型天疱疮棘层松解的位置发生在表皮中上部的患者抗Dsg1、3抗体指标值与棘层松解发生在基底层上方的患者相比有差异，但无统计学意义。结论 寻常型天疱疮及落叶型天疱疮患者组织病理中，棘层松解的位置可发生于表皮中上部、表皮中下部。棘层松解的位置可能与抗Dsg1抗体和抗Dsg3抗体指标值等相关。

Objective To analyze locations of acantholysis in pemphigus vulgaris（PV）and pemphigus foliaceus （PF）, so as to explain why acantholysis in pemphigus occurs in different locations of the epidermis. Methods Clinical data, histopathological and immunopathological findings, and pemphigus antibody level values were collected from 43 patients with PV and 28 with PF, and retrospectively analyzed. Results Of the 43 patients with PV, 35 showed acantholysis in the upper basal layer, 8 in the middle-to-upper epidermis. Of the 28 patients with PF, 25 showed acantholysis in the granular layer and the upper prickle cell layer, 3 in the middle-to-lower epidermis. Patients with PF showed significantly higher levels of anti-Desmoglein 1 （Dsg1） antibody compared with patients with PV （P = 0.047）. However, there were no significant differences in the levels of anti-Dsg1 and anti-Dsg3 antibodies between PV patients who had acantholysis in the middle-to-upper epidermis and those in the upper basal layer. Conclusion Histopatho-logical examinations of PV and PF lesions show that acantholysis can occur in the middle-to-upper epidermis, as well as in the middle-to-lower epidermis, and locations of acantholysis may be associated with levels of anti-Dsg1 and anti-Dsg3 antibodies.