Review Of Diagnosis And Therapy For Pemphigus And Pemphigoid With Measurement Of Serum Cytokines In Pemphigus Patients

OBJECTIVEPemphigus is relatively common among all the autoimmune bullous diseases and it's pathogenesis is quite complex.Nowadays,with the help of rapid development of Immunology and Molecular biology we could understand it further on the level of cytokines and cell immunity.However,the symptoms of pemphigus and pemphigoid are sometimes similar with other diseases,which makes it difficult to be diagnosed.Once onset,the severity of the disease could be quite different,which demands different criterion for treatment,ln this study,we aim to estimate ways of making diagnosis and purpose to have a general idea of the properly dosage of corticosteroid.1.A retrospective study of clinical diagnosis and therapy in 282 cases with pemphigus and 366 cases with pemphigoidMaterials and Methods:To analyze the diagnosis and therapy of pemphigus and pemphigoid.Results:The mean first-onset-age of pemphigus was smaller than pemphigoid(p＜0.001).In 175 patients of pemphigus confirmed by direct immunoflorescence(DIF),IgG deposition were 100%positive,while C₃ 92.0%.In 223 patients of pemphigoid,the proportion of C₃ positive was 99.1%.â‘ To patients of pemphigus,coincidence proportion of clinical diagnosis,pathology and DIF was 68.8%,while the proportion of the later two was 80.7%.â‘¡To patients of pemphigoid,consistent rate of clinical diagnosis,pathology and DIF was 62.8%,while the proportion of the later two was 78.1%.The patients were mainly treated by corticosteroids with a dosage of 0.5～1.5 mg·kg^-1·d^-1(prednisone).Conclusion:For cases of pemphigus and pemphigoid which can't be confirmed by clinical features and pathology,DIF is an important diagnostic method.Doctors in community hospital with limited funds could mainly test IgG and C₃ when the diagosis of pemphigus was doubtable.Similarly,they could mainly test C₃ if they consider pemphigoid as first diagnosis. Corticosteroid is the chief way for controlling the two diseases,while intra venous immunoglobulin(IVIG) could be added when necessary.2.Measurement of serum interleukin-4,6,10,17 and interferon-gamma levels in patients with pemphigusMaterials and Methods:Serum levels of interleukin-4,6,10,17 and interferon-gamma were determined by double antibody sandwich enzymelinked immunosorbent assay in 33 patients with pemphigus and in 34 normal controls.Results:Serum IL-6 and IL-17 levels were higher in patients with pemphigus than those of controls(p＜0.05).Serum levels of IFN-γand IL-10 were lower in patients with pemphigus than those of controls(p＜0.05).Conclusion:IL-6,IL-10,IFN-γand IL-17 might be involved in the pathogenesis of pemphigus.IL-17 might be a key factor among cytokines above.