Role of Direct Immunofluorescence in Diagnosis of Autoimmune Bullous Dermatoses: a Retrospective Analysis of 155 Cases
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摘要:
目的 探讨直接免疫荧光(direct immunofluorescence, DIF)技术在诊断自身免疫性大疱性皮肤病(autoimmune bullous dermatoses, AIBD)中的价值。 方法 回顾性分析2009年1月至2011年12月间北京协和医院皮肤科确诊的155例AIBD的DIF检查结果, 总结各类型AIBD的DIF表现特点, 并与组织病理检查对AIBD诊断的敏感性进行比较。 结果 各类型AIBD的DIF表现各具特征性。DIF诊断AIBD的敏感性为92.9%, 与组织病理检查敏感性(85.2%)比较差异无统计学意义(χ2=2.063, P=0.058)。 结论 DIF技术敏感性高, 对AIBD的诊断和鉴别诊断有重要意义。 Abstract:Objective To explore the diagnostic value of direct immunofluorescence (DIF) for autoimmune bullous dermatoses (AIBD). Methods The DIF features were reviewed in 155 AIBD patients who were admitted to Peking Union Medical College Hospital from January 2009 to December 2011. The diagnostic sensitivity of DIF was compared with that of histopathologic examination. Results Various types of AIBD showed different DIF features. The diagnostic sensitivity of DIF was 92.9%, which showed no significant difference with that of histopathologic findings (85.2%) (χ2=2.063, P=0.058). Conclusion DIF plays a significant role in the diagnosis and differential diagnosis of AIBD. -
Key words:
- bullous dermatoses /
- direct immunofluorescence /
- histopathology
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图 1 AIBD患者直接免疫荧光检查结果
A.天疱疮患者表皮细胞间弥漫网状荧光沉积(IgG,× 100); B. BP患者基底膜带连续线状荧光沉积(C3,× 100); C. DH患者基底膜带连续颗粒状荧光沉积(IgA,× 100); D. LABD患者基底膜带连续线状荧光沉积(IgA,× 100) AIBD、BP、DH、LABD:同表 1
表 1 155例AIBD患者的临床资料
疾病类型 例数 性别(男/女) 平均年龄(岁) 平均病程(月) 构成比(%) 天疱疮 68 35 /33 53. 0 (14 ~ 88) 18. 4 (0. 4 ~ 240) 43. 9 BP 84 54 /30 67. 3 (21 ~ 89) 8. 7 (0. 2 ~ 120) 54. 2 DH 2 2 / 0 34. 0 (15 ~ 53) 5. 5 (4. 9 ~ 6. 0) 1. 3 LABD 1 1 / 0 47 156 0. 6 合计 155 92 /63 - - 100 AIBD:自身免疫性大疱性皮肤病; BP:大疱性类天疱疮; DH:疱疹样皮炎; LABD:线状IgA大疱性皮病 表 2 各类型AIBD免疫荧光沉积的成分及方式
疾病类型 例数 免疫荧光抗体 沉积方式 IgA IgG IgM C3 天疱疮 68 2 (2. 9%) 62 (91. 2%) 3 (4. 4%) 59 (86. 8%) PE 10 1 (10. 0%) 10 (100. 0%) 1 (10. 0%) 9 (90. 0%) 表皮细胞间网状 PF 6 1 (16. 7%) 6 (100. 0%) 1 (16. 7%) 5 (83. 3%) 表皮细胞间网状 PVu 42 0 36 (85. 7%) 0 37 (88. 1%) 表皮细胞间网状 PVe 2 0 2 (100. 0%) 0 2 (100. 0%) 表皮细胞间网状 PH 5 0 5 (100. 0%) 1 (20. 0%) 3 (60. 0%) 表皮细胞间网状 PNP 3 0 3 (100. 0%) 0 3 (100. 0%) 表皮细胞间网状 基底膜带连续线状 BP 84 4 (4. 8%) 69 (82. 1%) 3 (3. 6%) 74 (88. 1%) 基底膜带连续线状 DH 2 2 (100. 0%) 0 1 (50. 0%) 0 基底膜带颗粒状 真皮乳头颗粒状、团块状 LABD 1 1 (100. 0%) 0 0 0 基底膜带连续线状 PE:红斑型天疱疮; PF:落叶型天疱疮; PVu:寻常型天疱疮; PVe:增殖型天疱疮; PH:疱疹样天疱疮; PNP:副肿瘤天疱疮; AIBD、BP、DH、LABD:同表 1 表 3 AIBD直接免疫荧光与组织病理检查敏感性比较
疾病类型 例数 直接免疫荧光 组织病理 + - + - 天疱疮 68 65 (95. 6%) 3 (4. 4%) 57 (83. 8%) 11 (16. 2%) BP 84 76 (90. 5%) 8 (9. 5%) 75 (89. 3%) 9 (10. 7%) DH 2 2 (100. 0%) 0 0 2 (100. 0%) LABD 1 1 (100. 0%) 0 0 1 (100. 0%) 合计 155 144 (92. 9%) 11 (7. 1%) 132 (85. 2%) 23 (14. 8%) AIBD、BP、DH、LABD:同表 1 -
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