中华皮肤科杂志 ›› 1994, Vol. 27 ›› Issue (2): 76-79,127.

• 论著 • 上一篇    下一篇

表皮下大疱病的鉴别诊断和抗原表达区域性差别的研究

张学军1, 翁孟武2, 施守义2   

  1. 1. 上海医科大学皮肤病学研究所, 200040;
    2. 指导者
  • 收稿日期:1993-01-06 修回日期:1993-03-29 出版日期:1994-04-15 发布日期:1994-04-15
  • 基金资助:
    卫生部课题基金资助

Differential diagnosis of Subepidermal Bullous Diseases and the Regional Variation of Their Antigen Expression

ZHANG Xue-Jun1, WENG Meng-wu2, SHI Shou-Yi2   

  1. Institute of Dermatology, Shanghai Medical University, Shanghai 200040
  • Received:1993-01-06 Revised:1993-03-29 Online:1994-04-15 Published:1994-04-15

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摘要： 通过间接免疫荧光和盐裂皮损周围皮肤直接免疫荧光(简称盐裂DIF),分别研究正常人皮肤、类天疱疮(BP)及获得性大疱性表皮松解症(EBA)抗原表达的区域性差别和表皮下大疱病鉴别诊断。窝、肘窝、上背、下背、股内侧和下腹部皮肤BP抗原表达率较高;膝、阳窝、足背、肘、肘窝和下腹部皮肤EBA抗原表达率较高。皮肤DIF显示25例表皮下大疱病中16例(64%)基底膜带有C3或IgG或伴C3和IgA沉积;盐裂DIF表明25例(100%)均有IgG或伴C3和IgA沉积在表皮侧或真皮侧。结果提示,BP抗原高表达率与皮损好发部位相一致;EBA抗原高表达率一部分与皮损好发部位一致。盐裂DIF不仅提高DIF阳性率,而且根据免疫反应物沉积部位可以鉴别出BP与EBA以及大疱性系统性红斑狼疮。

关键词: 皮肤病,大疱性, 抗原, 诊断,鉴别

Abstract: Regional variation of bullous pemphigoid (BP) antigen and epidermolysis bullosa acquisita (ERA) antigen in normal human skin and differential diagnosis of subepidermal bullous diseases were respectively studied by indirect immunofluorescence and salt-spilt skin direct immunofluorescence (DIF).Higher expression of BP antigen was observed in popliteal fossa, antecubital fossa, upper back, lower back,medial side of thigh and lower abdomen.Higher expression of EBA antigen was observed in knee, popliteal fossa,dorsum of foot,antecubital fossa,elbow and lower abdomen.16 (64%) of 25 patients with subepidermal bullous diseases had basement membrane zone deposits of C3 or IgG and IgA by skin DIF.However,salt-split skin DIF showed that all (100%)of 25 patients had IgG or with C3 and IgA deposits on the epidermal or dermal side of salt-split skin.These rusults suggest that high expression of CP antigen in different regions of normal human skin correlates with the sites of predilection of BP lesions, but the expression of EBA antigen correlates partially with the sites of predilection of EBA lesions.Salt-split skin DIF can increase DIF positive rate and be used for the differential diagnosis of subepidermal bullous diseases depending on the sites of immunoglubin and complement deposited in salt-split skin.

Key words: Skin dieases, bullous, Antigens, Diagnosis, differential