抗BP180 IgG抗体ELISA值与妊娠类天疱疮的不良妊娠结局相关。

Anti-BP180 IgG antibody ELISA values correlate with adverse pregnancy outcomes in pemphigoid gestationis.

作者信息

Cordel Nadège, Flament Jasmine, Jouen Fabienne, Seta Vannina, Tancrède-Bohin Emmanuelle, Dahan Catherine Picard, Konstantinou Maria-Polina, Dereure Olivier, Quéreux Gaëlle, Prost Catherine, Bedane Christophe, Debarbieux Sébastien, Lacour Jean-Philippe, Dompmartin Anne, Wierzbicka-Hainaut Ewa, Villada Isabelle Bourgault, Oro Saskia Ingen Housz, Vabres Pierre, Richard Marie-Aleth, Delaporte Emmanuel, Pham-Ledard Anne, Leccia Marie-Thérèse, Litrowski Noémie, Michel Catherine, Lagrange Brigitte, D'Incan Michel, Abasq Claire, Duvert-Lehembre Sophie, Dupuy Alain, Alcaraz Isabelle, Breton-Guitarian Anne-Laure, Lombart Florian, Estève Eric, Machet Laurent, Del Giudice Pascal, Fenot Marion, Belmondo Thibaut, Morin Florence, Guérin Olivia, Benichou Jacques, Tressières Benoît, Joly Pascal

机构信息

Department of Dermatology and Clinical Immunology, Guadeloupe University Hospital, Pointe-à-Pitre, Guadeloupe.

Univ Rouen Normandie, FOCIS Center of Excellence PAn'THER, Rouen, France.

出版信息

J Eur Acad Dermatol Venereol. 2023 Jun;37(6):1207-1214. doi: 10.1111/jdv.18973. Epub 2023 Mar 6.

DOI:10.1111/jdv.18973

PMID:36802102

Abstract

BACKGROUND

Adverse pregnancy outcomes (APO) occur in 35% of patients with pemphigoid gestationis (PG). No biological predictor of APO has been established yet.

OBJECTIVES

To assess a potential relationship between the occurrence of APO and the serum value of anti-BP180 antibodies at the time of PG diagnosis.

METHODS

Multicentre retrospective study conducted from January 2009 to December 2019 in 35 secondary and tertiary care centres.

INCLUSION CRITERIA

(i) diagnosis of PG according to clinical, histological and immunological criteria, (ii) ELISA measurement of anti-BP180 IgG antibodies determined at the time of PG diagnosis with the same commercial kit and (iii) obstetrical data available.

RESULTS

Of the 95 patients with PG included, 42 had one or more APO, which mainly corresponded to preterm birth (n = 26), intrauterine growth restriction (IUGR) (n = 18) and small weight for gestational age at birth (n = 16). From a ROC curve, we identified a threshold of 150 IU ELISA value as the most discriminating to differentiate between patients with or without IUGR, with 78% sensitivity, 55% specificity, 30% positive and 91% negative predictive value. The threshold >150 IU was confirmed using a cross-validation based on bootstrap resampling, which showed that the median threshold was 159 IU. Upon adjusting for oral corticosteroid intake and main clinical predictors of APO, an ELISA value of >150 IU was associated with the occurrence of IUGR (OR = 5.11; 95% CI: 1.48-22.30; p = 0.016) but not with any other APO. The combination of blisters and ELISA values higher than 150 IU led to a 2.4-fold higher risk of all-cause APO (OR: 10.90; 95% CI: 2.33-82.3) relative to patients with blisters but lower values of anti-BP180 antibodies (OR of 4.54; 95% CI 0.92-34.2).

CONCLUSION

These findings suggest that anti-BP180 antibody ELISA value in combination with clinical markers is helpful in managing the risk of APO, in particular IUGR, in patients with PG.

摘要

背景

妊娠类天疱疮（PG）患者中35%会出现不良妊娠结局（APO）。目前尚未确立APO的生物学预测指标。

目的

评估PG诊断时APO的发生与抗BP180抗体血清值之间的潜在关系。

方法

2009年1月至2019年12月在35个二级和三级护理中心进行的多中心回顾性研究。

纳入标准

（i）根据临床、组织学和免疫学标准诊断为PG，（ii）使用相同商业试剂盒在PG诊断时通过酶联免疫吸附测定（ELISA）法检测抗BP180 IgG抗体，（iii）有产科数据。

结果

纳入的95例PG患者中，42例出现了一种或多种APO，主要为早产（n = 26）、宫内生长受限（IUGR）（n = 18）和出生时小于胎龄体重（n = 16）。通过ROC曲线，我们确定ELISA值150 IU为区分有无IUGR患者的最具鉴别力的阈值，敏感性为78%，特异性为55%，阳性预测值为30%，阴性预测值为91%。基于自助重采样的交叉验证证实阈值>150 IU，其中位阈值为159 IU。在调整口服糖皮质激素摄入量和APO的主要临床预测因素后，ELISA值>150 IU与IUGR的发生相关（比值比[OR]=5.11；95%置信区间[CI]：1.48 - 22.30；p = 0.016），但与其他APO无关。水疱与ELISA值高于150 IU同时存在时，相对于有水疱但抗BP180抗体值较低的患者，全因APO风险高2.4倍（OR：10.90；95% CI：2.33 - 82.3）（后者OR为4.54；95% CI 0.92 - 34.2）。