Harman K E, Gratian M J, Bhogal B S, Challacombe S J, Black M M
St John's Institute of Dermatology, St Thomas' Hospital, and Department of Oral Medicine and Pathology, Guy's Hospital, Guy's, King's and St Thomas' School of Medicine and Dentistry, King's College, London, U.K.
Br J Dermatol. 2000 Jun;142(6):1135-9. doi: 10.1046/j.1365-2133.2000.03538.x.
The aim of this study was to re-evaluate indirect immunofluorescence (IIF) comparing two substrates, normal human skin (HS) and monkey oesophagus (MO) using serum from 29 pemphigus patients classified according to the presence of serum autoantibodies to either desmoglein (Dsg) 1 or Dsg3 detected by enzyme-linked immunosorbent assay (ELISA). Overall, the sensitivity of IIF was 83% on HS and 90% on MO. When data from both substrates were combined, the sensitivity increased to 100%. When sera from pemphigus foliaceus (PF) patients were studied, which contained Dsg1 antibodies only, the sensitivity of IIF was greatest on HS and titres were on average 4.8 doubling dilutions higher than on MO. In contrast, when sera containing autoantibodies only to Dsg3 from pemphigus vulgaris (PV) patients was studied, the sensitivity was greatest on MO and titres were on average 4.4 doubling dilutions higher than on HS. There was a significant correlation between Dsg1 antibody levels and IIF titres on HS and between Dsg3 antibody levels and IIF titres on MO. The investigation of immunobullous disorders in the future is likely to move towards antigen-specific techniques such as the Dsg ELISAs used in this study. However, in laboratories which currently rely on IIF for detecting pemphigus autoantibodies, the data presented in this study strongly suggest that two substrates should be used for IIF screening: one rich in Dsg1, such as HS, and the other rich in Dsg3, such as MO. This combination of substrates should not only increase the sensitivity of detecting pemphigus antibodies, but will aid in the differentiation of PV from PF. It is also possible that the data might be more useful for disease monitoring.
本研究的目的是重新评估间接免疫荧光法（IIF），比较两种底物，即正常人皮肤（HS）和猴食管（MO），使用的血清来自29例天疱疮患者，这些患者根据酶联免疫吸附测定（ELISA）检测到的针对桥粒芯糖蛋白（Dsg）1或Dsg3的血清自身抗体的存在进行分类。总体而言，IIF在HS上的敏感性为83%，在MO上为90%。当两种底物的数据合并时，敏感性提高到100%。当研究落叶型天疱疮（PF）患者的血清时，其仅含有Dsg1抗体，IIF在HS上的敏感性最高，滴度平均比在MO上高4.8个稀释倍数。相反，当研究寻常型天疱疮（PV）患者仅针对Dsg3的自身抗体血清时，敏感性在MO上最高，滴度平均比在HS上高4.4个稀释倍数。HS上的Dsg1抗体水平与IIF滴度之间以及MO上的Dsg3抗体水平与IIF滴度之间存在显著相关性。未来对免疫性大疱性疾病的研究可能会朝着抗原特异性技术发展，如本研究中使用的Dsg ELISA。然而，在目前依赖IIF检测天疱疮自身抗体的实验室中，本研究提供的数据强烈表明，IIF筛查应使用两种底物：一种富含Dsg1，如HS，另一种富含Dsg3，如MO。这种底物组合不仅应提高检测天疱疮抗体的敏感性，还将有助于区分PV和PF。这些数据也可能对疾病监测更有用。
