ELISA Testing of Anti-Desmoglein 1 and 3 Antibodies in the Management of Pemphigus
ELISA Testing of Anti-Desmoglein 1 and 3 Antibodies in the Management of Pemphigus
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DOI：
10.1001/archdermatol.2009.9
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发表时间：
2009-05-01
影响因子：
--
通讯作者：
Joly, Pascal
中科院分区：
文献类型：
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作者：
Abasq, Claire;Mouquet, Hugo;Joly, Pascal
目的：评估抗桥粒芯糖蛋白（Dsg）1和抗Dsg 3抗体（Ab）酶联免疫吸附测定（ELISA）值对天疱疮复发发生的预测价值。设计：回顾性研究。设置：法国13所大学医院的皮肤科。患者：研究人群包括26名具有天疱疮典型临床、组织学和免疫荧光结果的患者，主要结果：在患者的随访检查中记录了一系列抗Dsg 1和抗Dsg 3抗体ELISA值，并与皮肤和/或粘膜复发的发生相关。在初始治疗后，在落叶型天疱疮或寻常型天疱疮患者的血清样品中观察到抗Dsg 1（P < .001）和抗Dsg 3（P < .001）Ab ELISA值的显著降低。在长期随访期间，抗Dsg 1 Ab ELISA值与皮肤病变的病程相关（P= 0.03）;抗Dsg 1 Ab ELISA值的20 U/mL截止值为皮肤复发的发生提供了79%的阳性预测值和84%的阴性预测值。未观察到抗Dsg 3 Ab ELISA值与粘膜病变病程之间的相关性（P= 0.13）。在5/5例复发患者和10/13例持续粘膜缓解患者中观察到高于14 U/mL临界值的抗Dsg 3 Ab ELISA值，灵敏度为100%，但特异性较差，为23%。根据受试者工作特征曲线计算抗Dsg 3抗体的截止值为130 U/mL，并提供了84%的阳性和81%的阴性预测值。结论：抗Dsg 1抗体ELISA值比抗Dsg 3抗体ELISA值与寻常型天疱疮或落叶型天疱疮患者的病程密切相关。天疱疮患者的管理应考虑到这一点。
Objective: To assess the predictive value of anti desmoglein (Dsg) 1 and anti-Dsg3 antibody (Ab) enzyme-linked immunosorbent assay (ELISA) values for the occurrence of relapses in pemphigus.Design: Retrospective study.Setting: Dermatology departments from 13 university hospitals in France.Patients: The study population comprised 26 patients with typical clinical, histologic, and immunofluorescence findings of pemphigus, who were followed up over a 17-month period.Main Outcome Measures: Serial anti-Dsg1 and anti-Dsg3 Ab ELISA values were recorded during the patients' follow-up examinations and correlated with the occurrence of skin and/or mucosal relapses.Results: A significant reduction of anti-Dsg1 (P < .001) and anti-Dsg3 (P < .001) Ab ELISA values was observed in serum samples from patients with pemphigus foliaceus or pemphigus vulgaris after the initial treatment. During the long-term follow-up, anti-Dsg1 Ab ELISA values correlated with the course of skin lesions (P=.03); the 20 U/mL cutoff for the anti-Dsg1 Ab ELISA value provided a 79% positive and an 84% negative predictive value for the occurrence of cutaneous relapses. No correlation was observed between anti-Dsg3 Ab ELISA values and the course of mucosal lesions (P=.13). Anti-Dsg3 Ab ELISA values higher than the 14-U/mL cutoff were observed in 5 of the 5 patients with relapse and in 10 of the 13 patients with ongoing mucosal remission, providing a 100% sensitivity but a poor specificity of 23%. A cutoff value of 130 U/mL for anti-Dsg3 Abs was calculated based on the receiver operating characteristics curve and provided an 84% positive and an 81% negative predictive value.Conclusions: Anti-Dsg1 Ab ELISA values are more closely correlated than anti-Dsg3 Ab ELISA values with the course of the disease in patients with pemphigus vulgaris or pemphigus foliaceus. This should be taken into account for the management of patients with pemphigus.