中华皮肤科杂志 ›› 2019, Vol. 52 ›› Issue (2): 81-85.doi: 10.3760/cma.j.issn.0412-4030.2019.02.002

• 论著 • 上一篇    下一篇

不同底物间接免疫荧光对自身免疫性表皮下水疱病诊断的评价

于灵1    冯素英1    李志量1    靳培英1    王宝玺2   

  1. 1中国医学科学院  北京协和医学院  皮肤病医院皮肤科  江苏省皮肤病与性病分子生物学重点实验室，南京 210042；2中国医学科学院  北京协和医学院
    整形外科医院皮肤科，北京 100144
    于灵现在河南省人民医院皮肤科，郑州 450003
  • 收稿日期:2018-07-09 修回日期:2018-12-07 出版日期:2019-02-15 发布日期:2019-01-29
  • 通讯作者: 冯素英；李志量 E-mail:fengsuying2010@aliyun.com; Email：sdwhlzl@163.com
  • 基金资助:
    国家自然科学基金（81602781）；中国医学科学院医学与健康科技创新工程项目（CIFMS-2017-I2M-1-017）；江苏省自然科学基金（BK20160153）

Evaluation of the value of indirect immunofluorescence on different substrates in the diagnosis of autoimmune subepidermal bullous diseases

Yu Ling1, Feng Suying1, Li Zhiliang1, Jin Peiying1, Wang Baoxi2   

  1. 1Department of Dermatology, Institute of Dermatology and Hospital for Skin Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing 210042, China; 2Department of Dermatology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China
    Yu Ling is working on the Department of Dermatology, Henan Provincial People′s Hospital, Zhengzhou 450003, China
  • Received:2018-07-09 Revised:2018-12-07 Online:2019-02-15 Published:2019-01-29
  • Contact: Feng Suying; Li Zhiliang E-mail:fengsuying2010@aliyun.com; Email：sdwhlzl@163.com
  • Supported by:
    National Natural Science Foundation of China （81602781）; CAMS Innovation Fund for Medical Sciences （CIFMS?2017?I2M?1?017）; Natural Science Foundation of Jiangsu Province of China （BK20160153）

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摘要： 【摘要】 目的 评价以正常人皮肤、猴食管及盐裂皮肤为底物的间接免疫荧光对自身免疫性表皮下水疱病的诊断价值。方法 选取2015年1月至2016年12月在中国医学科学院皮肤病研究所诊断的自身免疫性表皮下水疱病56例，其中大疱性类天疱疮（BP）47例，获得性大疱性表皮松解症（EBA）6例，线状IgA大疱性皮病2例，P200类天疱疮1例。对照组为70例天疱疮、15例慢性湿疹和15例健康成人。分别以正常人皮肤、猴食管及盐裂皮肤为底物行间接免疫荧光，观察荧光沉积情况，比较不同表皮下水疱病间接免疫荧光检测的敏感性和特异性。采用SPSS 13.0软件，计数资料比较采用χ2检验。结果 BP患者血清以正常人皮肤、猴食管为底物间接免疫荧光可见到荧光物质沿基底膜带线性沉积，盐裂皮肤间接免疫荧光可见BP患者荧光线性沉积于表皮侧，EBA和P200类天疱疮线性沉积于真皮侧。以正常人皮肤、猴食管及盐裂皮肤为底物间接免疫荧光对表皮下水疱病诊断的敏感性分别为73.2%、60.7%、94.6%，差异有统计学意义（χ2 = 18.2，P < 0.05），特异性分别为98.0%、100%、97.1%，差异无统计学意义（P > 0.05），以盐裂皮肤为底物时诊断的敏感性高于以正常人皮肤、猴食管为底物（χ2值分别为8.0、16.7，均P < 0.05）。结论 对于自身免疫性表皮下水疱病的诊断，盐裂皮肤为底物行间接免疫荧光检查优于以猴食管和正常人皮肤为底物。

关键词: 荧光抗体技术, 间接； 类天疱疮, 大疱性； 自身免疫性表皮下水疱病； 诊断； 敏感性； 特异性

Abstract: 【Abstract】 Objective To evaluate the value of indirect immunofluorescence （IIF） on three different substrates including normal human skin （NS）, monkey esophagus （ME） and salt?split human skin （SS） in the diagnosis of autoimmune subepidermal bullous diseases. Methods A total of 56 patients with autoimmune subepidermal bullous diseases, including 47 with bullous pemphigoid （BP）, 6 with epidermolysis bullosa acquisita （EBA）, 2 with linear IgA bullous dermatosis, and 1 with anti?P200 pemphigoid, were diagnosed in and enrolled from Department of Dermatology, Institute of Dermatology, Chinese Academy of Medical Sciences between January 2015 and December 2016. Seventy patients with pemphigus, 15 patients with chronic eczema and 15 healthy adults served as controls. Blood samples collected from these patients and controls were subjected to IIF on three different substrates including NS, ME and SS, and the fluorescence deposition was observed. The sensitivities and specificities of IIF in the diagnosis of different subepidermal bullous diseases were compared. Statistical analysis was carried out with SPSS 13.0 software by using chi?square test for the comparison of enumeration data. Results IIF on NS or ME in the serum of patients with BP showed linear deposition of fluorescent material along the basement membrane zone. IIF on SS showed linear deposition of fluorescent material in the epidermis in the patients with BP, but in the dermis in the patients with EBA and anti?P200 pemphigoid. The sensitivities of IIF on NS, ME or SS in the diagnosis of subepidermal bullous diseases were 73.2%, 60.7% and 94.6% respectively, and the specificities were 98.0%, 100% and 97.1% respectively. There were significant differences among the sensitivities （χ2 = 18.2, P < 0.05）, but no significant difference was observed among the specificities（P > 0.05）. The diagnostic sensitivity of IIF on SS was significantly higher than that of IIF on NS or ME（χ2 = 8.0, 16.7, both P < 0.05）. Conclusion In the diagnosis of autoimmune subepidermal bullous diseases, IIF on SS is superior to IIF on ME or NS.

Key words: Fluorescent antibody technique, indirect, Pemphigoid, bullous, Autoimmune subepidermal bullous disease, Diagnosis, Sensitivity, Specificity