Malhi Kittu, Chatterjee Debajyoti, Mahajan Rahul, Handa Sanjeev, De Dipankar
Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Int J Dermatol. 2025 Feb;64(2):367-376. doi: 10.1111/ijd.17405. Epub 2024 Jul 31.
Prospective research is lacking on the utility of plucked hair outer root sheath direct immunofluorescence (ORS DIF) in the prediction of relapse in pemphigus vulgaris (PV) and the correlation of ORS DIF positivity with serum desmoglein antibody titers.
We performed a prospective cohort study enrolling 80 PV patients in complete clinical remission at a tertiary care center in North India. Study participants underwent ORS DIF at baseline, which was repeated every 3 months. Skin biopsy DIF was done at study inclusion, repeated at 3 months, and upon clinical relapse. An antidesmoglein antibody titer was assessed concurrently with ORS DIF in a subset of patients. Patients on adjuvant therapy had their adjuvant therapy withdrawn either at the initial visit, at 3 months, or at a 6-month follow-up. Our objectives were to determine the association between positive ORS DIF and clinical relapse, the correlation between positive ORS DIF and skin biopsy DIF, and between positive ORS DIF and positive antidesmoglein antibody titers (when concurrently done).
Twenty-two patients (27.5%) had a clinical relapse. Baseline immunological markers significantly associated with relapse are ORS DIF positivity with IgG (16/36 [45.44%] P = 0.005) and C3 (12/29 [41.37%] P = 0.047) and greater intensity of baseline IgG and C3 positivity in ORS DIF (IgG, P = 0.002; C3, P = 0.033). Notably, a significant correlation was observed between baseline positive ORS DIF and skin biopsy DIF (IgG, ρ = 0.695; C3, ρ = 0.498). Positive ORS DIF strongly correlated with positive anti-Dsg3 antibody titers (φs = 0.815; P < 0.01). Early withdrawal of adjuvant immunosuppressant (within 3 months) (P = 0.007) and positive ORS DIF were also associated with relapse (P = 0.017).
ORS DIF is a reliable predictor of PV clinical relapse and demonstrated robust correlations with skin biopsy DIF and antidesmoglein antibody titers. Periodic assessment of ORS DIF aids in determining new-onset positivity that heralds clinical relapse.
关于拔毛外根鞘直接免疫荧光法（ORS DIF）在寻常型天疱疮（PV）复发预测中的效用以及ORS DIF阳性与血清桥粒芯糖蛋白抗体滴度之间的相关性，目前缺乏前瞻性研究。
我们在印度北部一家三级医疗中心进行了一项前瞻性队列研究，纳入80例处于完全临床缓解期的PV患者。研究参与者在基线时接受ORS DIF检测，每3个月重复一次。在研究纳入时、3个月时以及临床复发时进行皮肤活检DIF检测。在一部分患者中，同时评估抗桥粒芯糖蛋白抗体滴度与ORS DIF。接受辅助治疗的患者在初次就诊时、3个月时或6个月随访时停用辅助治疗。我们的目标是确定ORS DIF阳性与临床复发之间的关联、ORS DIF阳性与皮肤活检DIF之间的相关性以及ORS DIF阳性与抗桥粒芯糖蛋白抗体滴度阳性之间的相关性（当同时进行检测时）。
22例患者（27.5%）出现临床复发。与复发显著相关的基线免疫标志物是ORS DIF中IgG阳性（16/36 [45.44%]，P = 0.005）和C3阳性（12/29 [41.37%]，P = 0.047），以及ORS DIF中基线IgG和C3阳性强度更高（IgG，P = 0.002；C3，P = 0.033）。值得注意的是，观察到基线ORS DIF阳性与皮肤活检DIF之间存在显著相关性（IgG，ρ = 0.695；C3，ρ = 0.498）。ORS DIF阳性与抗Dsg3抗体滴度阳性密切相关（φs = 0.815；P < 0.01）。辅助免疫抑制剂的早期停用（在3个月内）（P = 0.007）和ORS DIF阳性也与复发相关（P = 0.017）。
ORS DIF是PV临床复发的可靠预测指标，并且与皮肤活检DIF和抗桥粒芯糖蛋白抗体滴度显示出强相关性。定期评估ORS DIF有助于确定预示临床复发的新发阳性情况。
