Background

Bullous pemphigoid (BP), the most common autoimmune blistering disease, may be diagnostically challenging. Direct immunofluorescence (DIF), indirect immunofluorescence (IIF), enzyme-linked immunosorbent assay (ELISA), and recently, C3d immunohistochemistry (IHC), are used as adjuncts to diagnosis.

Objective

To compare C3d IHC to DIF, IIF, and ELISA testing in BP diagnosis.

Methods

C3d IHC was performed on skin biopsy specimens from 51 patients (27 with BP and 24 with other blistering diseases) and compared to DIF and IIF, with anti-BP180 or anti-BP230 ELISA results used as the gold standard.

Results

We found C3d IHC, DIF, and IIF had similar sensitivity (74.1%, 63.1%, and 70.4%), specificity (95.8%, 100%, and 100%), positive predictive value (95.2%, 100%, and 100%), and negative predictive value (76.7%, 70.6%, and 75%) for BP. Cases with positive C3d IHC, DIF, and IIF had significantly higher anti-BP180 and anti-BP230 by ELISA than cases with negative testing (P < .0001). False-negative IIF results were associated with lower BP230 compared with true-positive results (P = .03).

Limitations

This was a single-center, retrospective study.

Conclusion

Our study compared C3d IHC to DIF and IIF in BP diagnosis, demonstrating C3d IHC on fixed tissue provides similar diagnostic utility to immunofluorescence and ELISA.

中文翻译：

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C3d免疫组织化学染色与酶联免疫吸附法和免疫荧光法在大疱性类天疱疮诊断中的比较。

背景

大疱性天疱疮（BP）是最常见的自身免疫性水疱性疾病，可能在诊断上具有挑战性。直接免疫荧光（DIF），间接免疫荧光（IIF），酶联免疫吸附测定（ELISA）和最近使用的C3d免疫组织化学（IHC）作为诊断的辅助手段。

目的

要将C3d IHC与DIF，IIF和ELISA测试在BP诊断中进行比较。

方法

对51例患者的皮肤活检标本进行了C3d IHC（27例BP，24例其他水疱性疾病），并与DIF和IIF进行了比较，并将抗BP180或抗BP230 ELISA结果用作金标准。

结果

我们发现C3d IHC，DIF和IIF具有相似的敏感性（74.1％，63.1％和70.4％），特异性（95.8％，100％和100％），阳性预测值（95.2％，100％和100％） ）和BP的阴性预测值（76.7％，70.6％和75％）。C3d IHC，DIF和IIF阳性的病例通过ELISA的抗BP180和抗BP230显着高于阴性检测的病例（P  <.0001）。与真阳性结果相比，假阴性IIF结果与较低的BP230相关（P  = .03）。

局限性

这是一项单中心回顾性研究。

结论

我们的研究将C3d IHC与DIF和IIF在BP诊断中进行了比较，证明了固定组织上的C3d IHC提供了与免疫荧光和ELISA类似的诊断工具。