3种方法诊断口腔黏膜类天疱疮的有效性比较  

Comparison of the efficacy of 3 technics in the diagnosis of oral mucosal pemphigoid

作　　者：汪玉红 刘源 卫明慧 汪苑苑 王新文 WANG Yuhong;LIU Yuan;WEI Minghui;WANG Yuanyuan;WANG Xinwen(State Key Laboratory of Oral&Maxillofacial Reconstruction and Regeneration,National Clinical Research Center for Oral Diseases,Shaanxi Clinical Research Center for Oral Diseases,Department of Oral Medicine,Xi'an 710032,China;Department of Pathology,The Third Affiliated Hosptital of Air Force Medical University,Xi'an 710032,China)

机构地区：[1]口颌系统重建与再生全国重点实验室,国家口腔疾病临床医学研究中心,陕西省口腔疾病临床医学研究中心,空军军医大学第三附属医院口腔黏膜病科,西安710032 [2]空军军医大学第三附属医院口腔组织病理学教研室,西安710032

出　　处：《实用口腔医学杂志》2024年第4期547-551,共5页Journal of Practical Stomatology

基　　金：国家口腔疾病临床医学研究中心课题(编号:LCA202206);空军军医大学第三附属医院新技术项目(编号:LX2023408)。

摘　　要：目的:比较组织病理(HE)、直接免疫荧光(DIF)和血清抗BP180/BP230 ELISA抗体检测(BP180/BP230)诊断口腔黏膜类天疱疮(MMP)的有效性。方法:纳入MMP患者53例的病例资料,分析、比较以上病例中HE、DIF、血清BP180/230检查结果。结果:综合3种检查的结果,最终48例患者确诊为MMP。其中男性8例(16.7%),女性40例(83.3%),年龄34~76岁(中位年龄62岁),病程中位数9月(四分位数3~12月)。6例患者病损累及口腔外部位,依次为皮肤(n=3,6.3%)、生殖器(n=2,4.2%),咽喉(n=1,2.1%)。口腔黏膜主要受累部位为牙龈(n=40,83.3%)、腭部(n=22,45.8%)、颊部(n=15,31.3%)、舌部(n=4,8.3%)、唇部(n=3,6.3%)。HE诊断率为83.3%(40/48),漏诊率为16.7%(8/48);DIF诊断率为85.4%(41/48),漏诊率为14.6%(7/48);BP180/230 ELISA诊断率47.9%(23/48),漏诊率为52.1%(25/48)。HE与DIF的一致性Kappa系数为0.354(95%CI:0.060,0.648),BP180/230与DIF的一致性Kappa系数为-0.112(95%CI:-0.328,0.104),HE与BP180/230 ELISA的一致性Kappa系数为0.031(95%CI:-0.181,0.243)。结论:HE和DIF对MMP诊断的有效率接近,二者可互补;ELISA检测酌情作为补充检查,以提高MMP诊断的准确性。Objective:To compare the efficacy of histopathology(HE),direct immunofluorescence(DIF)and serum anti-BP180/BP230 antibody ELISA detection(BP180/BP230)in the diagnosis of oral mucous membrane pemphigoid(MMP).Methods:53 patients with MMP were included.HE,DIF and serum BP180/230 test results were analyzed and compared.Results:MMP was finally diagnosed in 48 patients by the comprehensive utilization of the 3 techics.There were 8 males(16.7%)and 40 females(83.3%),aged 34-76 years(median age 62 years),with a median duration of 9 months and an interquartile range of 3-12 months.6 patients had extraoral sites involvement,including skin(n=3,6.3%),genitalia(n=2,4.2%)and throat(n=1,2.1%).The main site of oral mucosa involvement was gingiva(n=40,83.3%),followed by palate(n=22,45.8%),cheek(n=15,31.3%),tongue(n=4,8.3%)and lip(n=3,6.3%).The sensitivity of the routine HE combined with modified biopsy was 83.3%(40/48)and missed diagnosis rate was 16.7%(8/48);the sensitivity of DIF was 85.4%(41/48)and missed diagnosis rate was 14.6%(7/48);the sensitivity of BP180/230 was 47.9%(23/48)and missed diagnosis rate was 52.1%(25/48).The kappa coefficient of agreement between HE and DIF was 0.354(95%CI:0.060,0.648),between BP180/230 ELISA and DIF was-0.112(95%CI:-0.328,0.104),and between HE and BP180/230 ELISA was 0.031(95%CI:-0.181,0.243).Conclusion:HE and DIF have similar effective rate for MMP diagnosis,and they can complement each other.ELISA detection can be used as a supplementary examination for the more accurate diagnostic of MMP.

关 键 词：直接免疫荧光 酶联免疫吸附试验 诊断率 类天疱疮 

分 类 号：R781.5[医药卫生—口腔医学]