| Objective:The serum osteopontin(osteopontin, OPN) and soluble CD40ligand (sCD40L) levels of pemphigus vulgaris patients and normal control group were detected by enzyme-linked immunosorbent assay,at the same time, a clinical analysis of48PV patients for same period was conducted.In order to studied the general condition, the causes,clinical manifestations and laboratory examinations of PV patients, and compared the similarities and differences with relevant domestic and foreign literature to their. And to explore the expression and significance of serum OPN and sCD40L of PV patients which will provide ideas to further improve the diagnosis, correctly evaluate the condition of the disease, formulate reasonable treatment and improve the prognosis.Method:(1) Collection cases:Hospitalized patients with incipient or recurrence PV patients between2011.7-2013.1in in-patient department of our hospital were enrolled. Record cases of the general condition, the clinical features, laboratory examinations and related autoantibodies. I studied the clinical analysis by retrospective analysis assay.(2) The concentration of serum OPN and sCD40L for31cases of pemphigus vulgaris patients and35healthy controls were detected by enzyme-linked immunosorbent assay.(3)Dealing with the data using SPSS17.0and excell statistical software to draw relevant conclusions.Results:The first part (1) General condition:1) Gender:26males and22females, and male to female ratio is1.18:1.2) Age:The youngest is20years old, while the oldest is68years, with an average age of47.29±13.13years. The average age is (49.23±12.55) years for the male group and (45.00±13.71) years for the female group, there is no difference for the onset age between male and female.3) Course of the disease:the shortest duration was one month,while the longest was six years, and the average duration of17.74±17.37months. Average duration was14.59±15.01months for male and21.46±19.51months for female. There is no difference for course of the disease between male and female4) Hospital stay:The shortest hospital stay was6days, while the longest was30days,and the average hospital stay was16.35±5.99days.The average hospital stay was17.84±6.60days for male and14.73±4.90days for female, there was no statistically significant difference between male and female(P=0.073>0.05).(2)The causes,clinical manifestations and laboratory examinations:The causes:48cases of PV patients,20(41.6%) incipient patients,28(58.4%)recurrence patients.Among incipient patients,18cases (37.4%) with no significant incentives, and1case (2.1%) were induced after appendicitis operation,1case (2.1%) induced by virus infection. Recurrent reasons:10cases (20.9%) for irregular medication,8cases (16.7%) to stop drug by oneself,5cases (10.4%) for the drugs to a certain dose,5cases (10.4%) for the infection.5patients’s secretions or blister fluid bacterial culture were:staphylococcus aureus.clinical manifestations:1) The first region:Among the48PV patients,23(47.9%) cases started in the oral mucosa,15patients of Severe group started in the oral mucosa, oral mucosa incidence for Severe group was higher than that for the light, mild group (P=0.027<0.05);2) Type of damage:27(52.1%) cases with skin mucous membrane affected,while21(48.9%) cases with skin involvement only,15patients in Severe group with skin mucous membrane affected. Skin mucous membrane involvement were higher for severe group than the light, mild group;3) Subjective symptoms:16cases (33.3%) with intense itching,32cases (67.7%) with pain,9cases(18.8%)with intense itching and pain.4) Nikolsky sign:30cases(62.5%)with positive Nikolsky sign,18cases(37.5%) with negative Nikolsky sign.16cases in Severe group were positive Nepal sign, positive Nikolsky sign rate for Severe group were significantly higher than that for the light, mild group (P<0.05).Laboratory examinations:1)Routine laboratory examinations:16cases (33.3%) with higher white blood cell count;11cases(22.9%) with higher platelet count;6cases with ESR increasing,13cases(27.08%) with Serum total protein decreasing,12cases (25%) with albumin decreasing,15cases (31.25%) with white ball decreasing,7cases(14.5%) with C3decreasing,8cases (16.7%) with CRP elevating,10cases (20.8%) with dyslipidemia,9cases (18.75%) with liver functionabnormal, the difference of Erythrocytes, leukocytes, platelets, globulin, hemoglobin, ESR, etc between the Severe group and the light, mild group had no statistical significance(P>0.05),2) Skin tissue biopsy and direct immunofluorescence:30patients did the skin tissue biopsy,24cases(80%) were positive,6cases(20%) were negative.30patients did skin direct immunofluorescence check,28patients of IgG positive (93.3%),26cases of C3(86.7%) positive,2patients(7%) with IgA positive,no patients with IgM positive.24cases (80%)both with IgG and C3positive.3) The detection of serum specific antibodies against Dsgl and Dsg3:31PV patients carried out the detection of serum specific antibodies against Dsgl and Dsg3. The serum anti Dsg3level in skin mucous membrane affected group was higer than that in the skin involvement group (P=0.000<0.01), with significantly statistical differences. The serum anti Dsgl levels between skin and mucous membrane affected group and skin involvement group had no difference (P=0.966>0.05). Statistical analysis according to the severty of illness: serum anti Dsg3level, anti Dsgl level between the light group levels and the severe group had no difference (P>0.05).The second part(1)The serum levels of OPN in pemphigus group was significantly higher than that in the healthy control group (P<0.01); the serum levels of OPN in mucous membrane group was higher than that in the skin involvement group (P=0.046<0.05); The serum levels of OPN in Co-infection group was significantly higher than that in the uninfection group (P=0.000<0.01); The serum levels of OPN between PV patients with higer level of platelet group and the normal level of platelet group had no difference (P>0.05); In PV patients, the serum levels of OPN was significantly positive related to the anti-Dsg3antibody (rs=0.489, P=0.489<0.01), and the anti Dsgl antibody (rs=0.383, P=0.383<0.05).And was significantly negative related to C3(rs=0.594, P=0.594<0.01), and have no correlation with immunoglobulin IgG, IgA, IgM, white blood cell (WBC), red blood cells (RBC) and platelet (PLT)(P>0.05).(2)The serum levels of sCD40L in healthy control group was significantly higher than that in the pemphigus group (P<0.01); the serum levels of sCD40L between the mucous membrane group and the skin involvement group had no difference (P=0.451>0.05); the serum levels of sCD40L between Co-infection group and the uninfection group had no difference (P=0.623>0.05); the serum levels of sCD40L between PV patients with higer level of platelet group and the normal level of platelet group had no difference (P>0.05); In PV patients,the serum levels of OPN have no correlation with anti-Dsg3antibody, anti Dsgl antibody, C3, immunoglobulin IgG, IgA, IgM, white blood cell (WBC), red blood cells (RBC) and platelet (PLT)(P>0.05).Conclusion:(1) The general situation, clinical symptoms, laboratory indexes of the PV patients enrolled into the group were coincide with domestic and foreign literature(2) Anti-Dsg3Dsgl higher titer,accompanied by mucous membrane involvement, positive nikolsky sign,Secondary infection of skin lesions,the ache of skin lesions aggravated to indicate a severity condition.(3) Infection was an important reason of recurrence, escalated the severity of disease in PV patients.(4) The serum levels of OPN in pemphigus patients were higher, especially those with skin and mucous membrane involvement.At the same time, the serum levels of OPN was significantly positive related to PV antibody titers. OPN play a role in pemphigus disease process and can be a monitoring indicator of disease activity and severity of pemphigus.(5) The serum level of sCD40L in PV patients is lower than the normal control group. |
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