综合评价ELISA法诊断口腔天疱疮的应用价值  

Comprehensive evaluations of the value for ELISA in the diagnosis of oral pemphigus

作　　者：程喆 文静 韩莹[1] 金建秋[1] 李斌斌[2] 宋江园 徐偲 刘晓丹 崔红梅 赵忠芳 王倩[1] 郭骧 鲁明星 刘宏伟[1] CHENG Zhe;WEN Jing;HAN Ying;JIN Jianqiu;LI Binbin;SONG Jiangyuan;XU Si;LIU Xiaodan;CUI Hongmei;ZHAO Zhongfang;WANG Qian;GUO Xiang;LU Mingxing;LIU Hongwei(Department of Oral Mucosa,Stomatological Hospital,Peking University,Haidian District,Beijing 100081)

机构地区：[1]北京大学口腔医院口腔黏膜科,100081 [2]北京大学口腔医院口腔病理科,100081 [3]西北民族大学口腔医学院口腔科

出　　处：《现代口腔医学杂志》2021年第5期289-293,共5页Journal of Modern Stomatology

摘　　要：目的通过多因素分析和ROC曲线等诊断实验指标综合评价酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)诊断口腔天疱疮的价值。方法选取2010.1.1~2019.12.31期间于北京大学口腔医院口腔黏膜科确诊为天疱疮的140例患者作为实验组,选取同期确诊为类天疱疮的157例患者作为对照组,两组患者均进行了ELSIA检查。统计患者人口学信息、临床表现及相应检查的结果,计算ELISA诊断口腔天疱疮的敏感度、特异性、准确度、阳性预测值、阴性预测值和约登指数。采用ROC曲线和Logistic回归分析评价ELSIA检查的诊断效能。结果ELSIA的敏感度为93.6%(131/140),特异性为93.6%(147/157),准确度为93.6%(279/297),阳性预测值为92.9%(131/141),阴性预测值为94.2%(147/156),约登指数为87.2%(93.6%+93.6%-1)。实验组和对照组在"抗Dsg3抗体阳性"、"云雾状水肿"和"年龄"因素上具有显著差异。ROC曲线分析显示抗Dsg3抗体阳性、ELISA结果和云雾状水肿的ROC曲线下面积是0.941、0.936和0.881,是>0.85的正向预测指标;Logistics回归分析显示:抗Dsg3抗体阳性(OR=23.332,P=0.000)、云雾状水肿(OR=19.725,P=0.000)、周缘扩展或尼氏征(OR=4.822,P=0.027)、年龄(OR=6.106,P=0.013)是诊断为天疱疮的危险因素。结论ELISA法在诊断口腔天疱疮时具有较高的正确诊断能力,是敏感且可靠的口腔天疱疮诊断方法;抗Dsg3抗体阳性相比抗Dsg1抗体阳性具有更高的诊断价值。Objective To evaluate the value of enzyme-linked immunosorbent assay(ELISA)in the diagnosis of oral pemphigus by multivariate analyses and ROC curve.Methods 140 patients diagnosed with pemphigus in the Department of Oral Mucosa of The Stomatological Hospital of Peking University from January 1,2010 to December31,2021 were selected as the experimental group,and 157 patients diagnosed with pemphigoid during the same period were selected as the control group.ELSIA examination was performed in both groups.The patient’s demographic information,clinical manifestations and corresponding examination results were counted,and the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of oral pemphigus were calculate.ROC curve and Logistic regression analysis were used to evaluate the diagnostic efficiency of ELSIA examination.Results ELSIA had a sensitivity of 93.6%(131/140),specificity of 93.6%(147/157),accuracy of93.6%(279/297),positive predictive value of 92.9%(131/141),negative predictive value of 94.2%(147/156),and jorden index of 87.2%(93.6%+93.6%-1).There were significant differences between the experimental group and the control group in"anti-DSG3 antibody positive","cloud edema"and"age".The ROC curve analysis showed that the area under the ROC curve of positive anti-dsg3 antibody,ELISA results and cloud edema was0.941,0.936 and 0.881,which were positive predictors of>0.85.Logistic regression analysis showed that positive anti-DSG3 antibody(OR=23.332,P=0.000),cloud edema(OR=19.725,P=0.000),peripheral expansion or Nikolsky’s sign(OR=4.822,P=0.027),and age(OR=6.106,P=0.013)were risk factors for pemphigus.Conclusion ELISA is a sensitive and reliable method in the diagnosis of oral pemphigus.Positive anti-DSG3 antibody has higher diagnostic value than positive anti-DSG1 antibody.

关 键 词：天疱疮 ELISA 抗Dsg3抗体 ROC曲线 Logistics回归分析 

分 类 号：R781.5[医药卫生—口腔医学]