Email Alert | RSS

北京大学学报（医学版） ›› 2026, Vol. 58 ›› Issue (1): 68-73. doi: 10.19723/j.issn.1671-167X.2026.01.009

• 论著 • 上一篇    下一篇

直接免疫荧光在口腔黏膜寻常型天疱疮诊断中的价值: 基于多指标联合分析的回顾性研究

池彦廷1,*, 蒋鸿杰1,2,*, 陈艳1, 徐志秀1,*(), 李斌斌1,*()   

  1. 1. 北京大学口腔医学院·口腔医院病理科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 口腔数字医学北京市重点实验室, 北京 100081
    2. 重庆医科大学附属口腔医院, 口腔疾病研究重庆市重点实验室, 口腔生物医学工程重庆市高校市级重点实验室, 重庆市卫生健康委员会口腔生物医学工程重点实验室, 重庆 401147
  • 收稿日期:2025-09-19 出版日期:2026-02-18 发布日期:2026-01-06
  • 通讯作者: 徐志秀, 李斌斌
  • 作者简介:

    *These authors contributed equally to this work

Value of direct immunofluorescence in the diagnosis of oral mucosal pemphigus vulgaris: A retrospective study based on multi-index combined analysis

Yanting CHI1, Hongjie JIANG1,2, Yan CHEN1, Zhixiu XU1,*(), Binbin LI1,*()   

  1. 1. Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. The Affiliated Stomatological Hospital of Chongqing Medical University & Chongqing Key Laboratory of Oral Diseases & Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education & Chongqing Municipal Health Commission Key Laboratory of Oral Biomedical Engineering, Chongqing 401147, China
  • Received:2025-09-19 Online:2026-02-18 Published:2026-01-06
  • Contact: Zhixiu XU, Binbin LI

RICH HTML

   

PDF (PC)

摘要：

目的: 基于多指标联合分析，探讨直接免疫荧光(direct immunofluorescence，DIF)对口腔黏膜寻常型天疱疮(pemphigus vulgaris，PV)的诊断效能。方法: 回顾性分析53例确诊口腔黏膜PV的患者，收集患者临床资料及DIF、组织病理学、血清学酶联免疫吸附试验(enzyme-linked immunosorbnent assay，ELISA)检测结果，采用灵敏度、特异度、受试者工作特征(receiver operating characteristic，ROC)曲线的曲线下面积(area under curve，AUC)等指标评估各方法的诊断效能。结果: 患者以中老年女性为主，颊黏膜为最常见受累部位，大部分患者伴有起疱史。DIF检测的阳性率为96.23%，主要表现为上皮棘细胞间网状绿色荧光沉积，其诊断价值最高，灵敏度为96.23%，特异度为100.00%，AUC值为0.981；组织病理学次之，灵敏度为94.34%，特异度为100.00%，AUC值为0.972；ELISA检测的灵敏度为82.61%，特异度为82.35%，AUC值为0.825。DIF与组织病理学、ELISA及临床诊断具有互补性，联合检测可提高诊断准确性。结论: DIF是诊断口腔黏膜PV的核心指标，建议采用“临床表现-DIF-组织病理学-ELISA”综合诊断流程；该综合诊断体系不仅能显著提升口腔黏膜PV诊断的精准度，也契合了精准医疗的核心理念，可为个性化治疗提供依据。

关键词: 口腔黏膜, 天疱疮, 荧光抗体技术, 直接, 诊断

Abstract:

Objective: To clarify the diagnostic efficacy of various diagnostic methods through multi-index combined analysis, and to explore the core diagnostic value of direct immunofluorescence (DIF) in oral mucosal pemphigus vulgaris (PV). Methods: A total of 53 patients with confirmed oral mucosal PV were included, retrospectively. Their data of DIF, histopathology, serum enzyme-linked immunosorbent assay (ELISA) and clinical diagnosis were systematically analyzed, and diagnostic efficacy of each method was evaluated using indicators, such as sensitivity, specificity, and area under curve (AUC) of the receiver operating characteristic (ROC) curve. Results: The results showed that among the 53 patients, middle-aged and elderly females were predominant, the buccal mucosa was the most common involved site, and most patients had a history of blistering. The positive rate of DIF was 96.23%, mainly manifested as a reticular fluorescent deposition between epithelial spinous cells, demonstrating the highest diagnostic value with a sensitivity of 96.23%, specificity of 100.00%, and AUC of 0.981. Histopathology ranked second, with a sensitivity of 94.34%, a specificity of 100.00%, and an AUC value of 0.972. The ELISA test had a sensitivity of 82.61%, a specificity of 82.35%, and an AUC value of 0.825. Although the sensitivity of clinical diagnosis was acceptable, its specificity was relatively low. Additionally, DIF exhibited complementarity with histopathology, ELISA, and clinical diagnosis, and combined testing could improve diagnostic accuracy. Conclusion: DIF is the "gold standard" for the diagnosis of oral mucosal PV. A comprehensive diagnostic workflow of "clinical manifestation-DIF-histopathology-ELISA" is proposed. This integrated diagnostic system not only significantly improves the accuracy of oral mucosal PV diagnosis but also aligns with the core principles of precision medicine, providing a basis for indivi-dualized treatment.

Key words: Mouth mucosa, Pemphigus, Fluorescent antibody technique, direct, Diagnosis

中图分类号: 

  • R781.5

图1

口腔黏膜寻常型天疱疮的组织病理学特征(HE染色)"

图2

口腔黏膜寻常型天疱疮的直接免疫荧光表现"

表1

2例直接免疫荧光结果阴性患者的诊断及治疗情况"

Patient Diagnosis Treatment
Clinical manifestation Histopathology Antibody level by ELISA/(U/mL) Treated with pemphigus protocol Used glucocorticoids Treatment outcome
No.1 Typical Atypical Anti-Dsg3: 93.70 (>20) Anti-Dsg1: 0 (< 20) Yes Yes Marked
No.2 Typical Atypical Anti-Dsg3: 58.44 (>20) Anti-Dsg1: 11.33 (< 20) Yes No Mild

表2

直接免疫荧光各抗体指标的诊断效能"

Detection indicator Sensitivity Specificity Positive predictive value Negative predictive value Missed diagnosis rate False positive rate
IgG 92.45% 55.00% 84.48% 73.33% 7.55% 45.00%
C3 52.83% 60.00% 77.78% 32.43% 47.17% 40.00%
Fibrinogen 20.75% 75.00% 68.75% 26.32% 79.25% 25.00%
IgA 5.66% 85.00% 50.00% 25.37% 94.34% 15.00%
IgM 1.89% 95.00% 50.00% 26.76% 98.11% 5.00%
DIF 96.23% 100.00% 100.00% 90.91% 3.77% 0.00%

图3

直接免疫荧光诊断口腔黏膜寻常型天疱疮的受试者工作特征曲线"

表3

口腔黏膜天疱疮中不同检测方法诊断效能的比较"

Detection method Sensitivity Specificity AUC
DIF 96.23% 100.00% 0.981
Histopathology 94.34% 100.00% 0.972
ELISA 82.61% 82.35% 0.825
Clinical diagnosis 86.79% 15.00% 0.509
1
Porro AM , Seque CA , Ferreira MCC , et al. Pemphigus vulgaris[J]. An Bras Dermatol, 2019, 94 (3): 264- 278.
2
Kridin K . Pemphigus group: Overview, epidemiology, mortality, and comorbidities[J]. Immunol Res, 2018, 66 (2): 255- 270.

doi: 10.1007/s12026-018-8986-7
3
Jamora MJJ , Jiao D , Bystryn JC . Antibodies to desmoglein 1 and 3, and the clinical phenotype of pemphigus vulgaris[J]. J Am Acad Dermatol, 2003, 48 (6): 976- 977.

doi: 10.1067/mjd.2003.438
4
Joly P , Horvath B , Patsatsi Α , et al. Updated S2K guidelines on the management of pemphigus vulgaris and foliaceus initiated by the European academy of dermatology and venereology (EADV)[J]. J Eur Acad Dermatol Venereol, 2020, 34 (9): 1900- 1913.

doi: 10.1111/jdv.16752
5
Witte M , Zillikens D , Schmidt E . Diagnosis of autoimmune blistering diseases[J]. Front Med (Lausanne), 2018, 5, 296.
6
Arockiam S , Raj B , Prabha N , et al. Diagnostic utility of immunofluorescence in oral lesions: A systematic review[J]. J Oral Maxillofac Res, 2024, 15 (3): e2.
7
Nili A , Salehi Farid A , Asgari M , et al. Current status and prospects for the diagnosis of pemphigus vulgaris[J]. Expert Rev Clin Immunol, 2021, 17 (8): 819- 834.
8
中国医疗保健国际交流促进会皮肤科分会. 寻常型天疱疮诊断和治疗专家建议(2020)[J]. 中华皮肤科杂志, 2020, 53 (1): 1- 7.
9
Mahmood MN . Direct immunofluorescence of skin and oral mucosa: Guidelines for selecting the optimum biopsy site[J]. Dermatopathology (Basel), 2024, 11 (1): 52- 61.

doi: 10.3390/dermatopathology11010006
10
Amagai M , Tanikawa A , Shimizu T , et al. Japanese guidelines for the management of pemphigus[J]. J Dermatol, 2014, 41 (6): 471- 486.

doi: 10.1111/1346-8138.12486
11
Mutasim DF , Adams BB . Immunofluorescence in dermatology[J]. J Am Acad Dermatol, 2001, 45 (6): 803- 824.

doi: 10.1067/mjd.2001.117518
12
Dridi SM , Lutz CM , Gaultier F , et al. Oral biopsy in mucous membrane pemphigoid and pemphigus vulgaris with gingival expression: The optimal site. A systematic review and meta-analysis[J]. BMC Oral Health, 2024, 24 (1): 1093.

doi: 10.1186/s12903-024-04853-y
13
Minz RW , Chhabra S , Singh S , et al. Direct immunofluorescence of skin biopsy: Perspective of an immunopathologist[J]. Indian J Dermatol Venereol Leprol, 2010, 76 (2): 150- 157.

doi: 10.4103/0378-6323.60561
14
Dainichi T , Chow Z , Kabashima K . IgG4, complement, and the mechanisms of blister formation in pemphigus and bullous pemphigoid[J]. J Dermatol Sci, 2017, 88 (3): 265- 270.

doi: 10.1016/j.jdermsci.2017.07.012
15
Xu Y , He X , Jie W , et al. The application of direct immunofluorescence in the pathological diagnosis of oral mucosal diseases: Series of 116 cases[J]. Pathol Res Pract, 2025, 270, 155989.

doi: 10.1016/j.prp.2025.155989
16
Arbache ST , Nogueira TG , Delgado L , et al. Immunofluorescence testing in the diagnosis of autoimmune blistering diseases: Overview of 10-year experience[J]. An Bras Dermatol, 2014, 89 (6): 885- 889.

doi: 10.1590/abd1806-4841.20143221
17
Buonavoglia A , Leone P , Dammacco R , et al. Pemphigus and mucous membrane pemphigoid: An update from diagnosis to therapy[J]. Autoimmun Rev, 2019, 18 (4): 349- 358.

doi: 10.1016/j.autrev.2019.02.005
18
Feng X , Zheng H , Wang M , et al. Autoimmune bullous diseases: Pathogenesis and clinical management[J]. Mol Biomed, 2025, 6 (1): 30.

doi: 10.1186/s43556-025-00272-9
19
Genovese G , Maronese CA , Casazza G , et al. Clinical and serological predictors of relapse in pemphigus: A study of 143 patients[J]. Clin Exp Dermatol, 2022, 47 (1): 98- 106.

doi: 10.1111/ced.14854
20
Harman KE , Seed PT , Gratian MJ , et al. The severity of cutaneous and oral pemphigus is related to desmoglein 1 and 3 antibody levels[J]. Br J Dermatol, 2001, 144 (4): 775- 780.

doi: 10.1046/j.1365-2133.2001.04132.x
21
Golinski ML , Lemieux A , Maho-Vaillant M , et al. The diversity of serum anti-DSG3 IgG subclasses has a major impact on pemphigus activity and is predictive of relapses after treatment with rituximab[J]. Front Immunol, 2022, 13, 849790.

doi: 10.3389/fimmu.2022.849790
[1] 赵业, 刁小莉, 熊焰. 细胞转移技术在微量细胞液病理诊断中的应用[J]. 北京大学学报（医学版）, 2026, 58(1): 208-213.
[2] 王月, 梁宇红. 繁茂型牙骨质-骨结构不良1例[J]. 北京大学学报（医学版）, 2026, 58(1): 220-224.
[3] 顾静妍, 李欣艺, 赵金霞, 穆荣. 误诊为类风湿关节炎、痛风的糖尿病致Charcot关节病1例[J]. 北京大学学报（医学版）, 2025, 57(6): 1193-1197.
[4] 肖晓笛, 夏有辰, 柳剑英, 付鹏. 左侧胸锁乳突肌间血管内乳头状内皮增生1例[J]. 北京大学学报（医学版）, 2025, 57(5): 1002-1004.
[5] 孙翔宇, 袁超, 周芯竹, 刁婧, 郑树国. 唾液微生态在口腔及全身疾病早期防治中的应用[J]. 北京大学学报（医学版）, 2025, 57(5): 859-863.
[6] 冷汶远, 高端, 李晓宇, 左炜, 胡伟民, 朱振鹏, 徐纯如, 林健, 李学松. 口腔黏膜补片与脱细胞真皮基质补片治疗长段尿道狭窄的疗效和安全性对比[J]. 北京大学学报（医学版）, 2025, 57(5): 975-979.
[7] 朱慧, 闵赛南, 苏家增, 陈艳, 彭歆, 于尧, 俞光岩. 口腔黏膜嗜酸性溃疡的临床病理分析[J]. 北京大学学报（医学版）, 2025, 57(3): 620-625.
[8] 陈钊, 邱永康, 康磊. 经典型Sweet综合征 18F-FDG PET/CT多脏器异常显像1例[J]. 北京大学学报（医学版）, 2025, 57(2): 403-407.
[9] 方媛媛, 徐帆, 雷杰, 张昊, 张文宇, 孙宇, 吴宏新, 傅开元, 毛伟玉. 基于颞下颌关节紊乱病诊断标准的临床自动诊断系统的建立及验证[J]. 北京大学学报（医学版）, 2025, 57(1): 192-201.
[10] 王鹃, 邱立新, 尉华杰. 下颌磨牙穿龈形态设计对种植体周围软组织影响的随机对照临床研究[J]. 北京大学学报（医学版）, 2025, 57(1): 65-72.
[11] 车佳璐, 刘子臣, 李琨, 张晨, 车南颖. 全自动EasyNAT核酸快速检测系统检测石蜡包埋组织诊断结核病的临床价值[J]. 北京大学学报（医学版）, 2024, 56(6): 1047-1051.
[12] 王杰, 王建伟, 夏海缀, 徐啸, 翟建坡, 何峰, 黄广林, 李贵忠. 阴茎远端尿道狭窄疾病的手术治疗方式[J]. 北京大学学报（医学版）, 2024, 56(6): 1075-1082.
[13] 陈心心, 唐哲, 乔艳春, 荣文笙. 北京市密云区4岁儿童患龋状况及其与龋活跃性检测的相关性[J]. 北京大学学报（医学版）, 2024, 56(5): 833-838.
[14] 钟华, 李原, 徐丽玲, 白明欣, 苏茵. 18F-FDG PET/CT在风湿免疫病中的应用[J]. 北京大学学报（医学版）, 2024, 56(5): 853-859.
[15] 李正芳,罗采南,武丽君,吴雪,孟新艳,陈晓梅,石亚妹,钟岩. 抗氨基甲酰化蛋白抗体在诊断类风湿关节炎中的应用价值[J]. 北京大学学报（医学版）, 2024, 56(4): 729-734.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
地址： 北京市海淀区学院路38号 北京大学医学部 《北京大学学报（医学版）》
邮编：100191
电话：010-82801551
Email： xbbjb2@bjmu.edu.cn

《北京大学学报（医学版）》
微信公众号
版权所有 © 2018 《北京大学学报（医学版）》编辑部