Correlation Between Anti-dsg Antibody And Pemphigus Condition And Guiding Effect Of Anti-dsg Antibody On Hormone Dosage

Objectives:1.To explore the relationship between anti-desmosome glycoprotein 1(Dsgl),Dsg3 antibody and clinical phenotype,disease activity and glucocorticoid dose in patients with pemphigus,to provide reference indicators for clinical diagnosis,disease evaluation and treatment planning of pemphigus;2.To observe the change trend of anti-Dsg antibody level and glucocorticoid dose in different treatment stages in patients of recurrence,and provide laboratory evidence for the adjustment of hormone dosage during the treatment processMethods:1.PDAI activity score was performed in 90 patients with pemphigus from January 2019 to January 2020.For all pemphigus patients,sex,age,clinical phenotype of pemphigus,level of anti-Dsg antibody,PDAI activity score and glucocorticoid dose were collected.SPSS 18.0 statistical software was used for statistical analysis,measurement datas between groups were compared by T test and analysis of variance.Enumeration dates were compared by chi-square test.Analysis of Pearson correlation was used to judge the correlation between the two groups,Scatter plot was drawn to calculate the linear regression equation;2.15 cases of pemphigus patients who diagnosed from January 2019 to January 2020 were reviewed.All patients who suffered a relapse were followed-up at least 3 months.SPSS 18.0 statistical software was used for statistical analysis.The measurement data were expressed as mean±standard deviation(x±SD).The pairwise comparison of data between groups were performed by Wilcoxon signed rank sum test of paired design.Results:1.There was significant difference in the positive rate of anti-Dsg 1 antibody and anti-Dsg3 antibody between PV group and PF group(P<0.001),and there was significant difference between anti-Dsg1 antibody and anti-Dsg3 antibody in skin group,mucous membrane group,skin and mucous membrane group(P<0.001);2.There was no significant difference in sex and age among mild,moderate and severe groups(P>0.05);3.Only in the anti-Dsg1 positive group,the anti-Dsg1 level was linearly correlated with the disease activity score(r=0.802,P<0.001).The linear regression equation was as follows:PDAI disease activity score=0.795+0.095×anti-Dsg1 antibody level.In the group with positive anti-Dsg1 and Dsg3,the level of anti-Dsg1 antibody and anti-Dsg3 antibody were linearly correlated with the score of disease activity(R=0.754,P<0.001).The multiple linear regression equation was as follows:PDAI disease activity score=-0.545+0.080xanti-Dsg1 antibody level+0.300×anti-Dsg3 antibody level.Only in the anti-Dsg3 antibody positive group,there was no significant difference in the level of anti-Dsg3 antibody between the mild group and the moderate group(P>0.05);4.There was a linear correlation between glucocorticoid dose and disease activity score(r=0.804,P<0.001).The linear regression equation was as follows:glucocorticoid dose=22.268+1.171 xPDAI disease activity score;5.The antibody levels after initial treatment in 15 patients who long-term followed-up were significantly lower than before initial treatment;the antibody levels during relapse were significantly higher than before relapse;the antibody level decreased significantly after the treatment of relapse compared with during relapse(P<0.05).Conclusions:1.The detection of anti-Dsg1 and Dsg3 antibodies by ELISA can be used as one of the diagnostic indicators of pemphigus and can be used as a differential index of PV/PF and skin/mucosal lesions;2.In pemphigus patients with positive anti-Dsg1 antibodies and both positive anti-Dsg1 and Dsg3 antibodies,the levels of anti-Dsg1 and Dsg3 antibodies are highly positively correlated with the disease activity of pemphigus.The levels of anti-Dsg1 and Dsg3 antibodies can be used as an effective indicators to judge the activity of pemphigus;3.The glucocorticoid dose is positively correlated with the disease activity score of patients with pemphigus.The higher the disease activity score,the higher the glucocorticoid dose should be given according to the clinical manifestations,so as to achieve the purpose of controlling the disease as soon as possible;4.According to the changes of the patient's condition,appropriate glucocorticoid dose adjustment or appropriate glucocorticoid shock therapy and immunoglobulin pulse therapy are helpful to remission of the disease;5.When the disease is under control,the recovery of anti-Dsg antibody can be used as a reference index to predict the recurrence of the disease;6.In different treatment stages of patients,changes in the level of anti-Dsg antibody can be used as one of the indicators to evaluate the therapeutic effect and monitor the change of the condition,which can guide glucocorticoid reduction.