{"title":"对老年大疱性类天疱疮诊断工具的回顾性比较","authors":"Yung-Chun Chang, Yu-Jun Chang, Hui-Ju Yang","doi":"10.1177/12034754241265700","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Older patients who are predisposed to bullous pemphigoid (BP) may exhibit reluctance to undergo skin biopsy due to potential complications.</p><p><strong>Objectives: </strong>This study aimed to conduct a comparative evaluation among histology, direct immunofluorescence (DIF), and indirect immunofluorescence (IIF) to determine the optimal diagnostic tool in elderly patients.</p><p><strong>Methods: </strong>A retrospective study was conducted on 841 patients suspected of having BP. All cases were initially classified as BP and non-BP in accordance with the diagnostic criteria. Student's <i>t</i>-test and chi-squared test examined differences between the 2 groups. We evaluated the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio detected by the 3 tools. We stratified the analysis by age to compare the performance of the diagnostic tools and examined the risk factors associated with BP using logistic regression.</p><p><strong>Results: </strong>Overall, histology exhibited the highest sensitivity (89.4%), while DIF demonstrated the highest specificity (67.1%). In the elderly, the IIF test exhibited the highest specificity (57.5%), the highest positive likelihood ratio (2.047), and the lowest negative likelihood ratio (0.226). Among patients taking Dipeptidyl Peptidase-4 (DPP-4) inhibitors, IIF demonstrated the highest positive likelihood ratio (3.194) and the second-lowest negative likelihood ratio (0.235).</p><p><strong>Conclusions: </strong>In cases that elderly patients suspected of having BP are reluctant to undergo skin biopsy, IIF demonstrates the optimal diagnostic method due to its highest positive likelihood ratio, the lowest negative likelihood ratio among the 3 diagnostic measures. Moreover, IIF is found to be a more effective tool for detecting BP in patients using DPP-4 inhibitors.</p>","PeriodicalId":15403,"journal":{"name":"Journal of Cutaneous Medicine and Surgery","volume":null,"pages":null},"PeriodicalIF":3.1000,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A Retrospective Comparison of Diagnostic Tools of Bullous Pemphigoid for Elderly Patients.\",\"authors\":\"Yung-Chun Chang, Yu-Jun Chang, Hui-Ju Yang\",\"doi\":\"10.1177/12034754241265700\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Older patients who are predisposed to bullous pemphigoid (BP) may exhibit reluctance to undergo skin biopsy due to potential complications.</p><p><strong>Objectives: </strong>This study aimed to conduct a comparative evaluation among histology, direct immunofluorescence (DIF), and indirect immunofluorescence (IIF) to determine the optimal diagnostic tool in elderly patients.</p><p><strong>Methods: </strong>A retrospective study was conducted on 841 patients suspected of having BP. All cases were initially classified as BP and non-BP in accordance with the diagnostic criteria. Student's <i>t</i>-test and chi-squared test examined differences between the 2 groups. We evaluated the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio detected by the 3 tools. We stratified the analysis by age to compare the performance of the diagnostic tools and examined the risk factors associated with BP using logistic regression.</p><p><strong>Results: </strong>Overall, histology exhibited the highest sensitivity (89.4%), while DIF demonstrated the highest specificity (67.1%). In the elderly, the IIF test exhibited the highest specificity (57.5%), the highest positive likelihood ratio (2.047), and the lowest negative likelihood ratio (0.226). Among patients taking Dipeptidyl Peptidase-4 (DPP-4) inhibitors, IIF demonstrated the highest positive likelihood ratio (3.194) and the second-lowest negative likelihood ratio (0.235).</p><p><strong>Conclusions: </strong>In cases that elderly patients suspected of having BP are reluctant to undergo skin biopsy, IIF demonstrates the optimal diagnostic method due to its highest positive likelihood ratio, the lowest negative likelihood ratio among the 3 diagnostic measures. 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引用次数: 0
摘要
背景:易患大疱性类天疱疮(BP)的老年患者可能因潜在并发症而不愿接受皮肤活检:本研究旨在对组织学、直接免疫荧光(DIF)和间接免疫荧光(IIF)进行比较评估,以确定老年患者的最佳诊断工具:对 841 例疑似 BP 患者进行了回顾性研究。所有病例均按照诊断标准被初步分为 BP 和非 BP。学生 t 检验和卡方检验检验了两组之间的差异。我们评估了 3 种工具检测到的敏感性、特异性、阳性预测值、阴性预测值、阳性似然比和阴性似然比。我们按年龄进行了分层分析,以比较诊断工具的性能,并使用逻辑回归法研究了与血压相关的风险因素:总体而言,组织学的灵敏度最高(89.4%),而 DIF 的特异性最高(67.1%)。在老年人中,IIF 检验的特异性最高(57.5%),阳性似然比最高(2.047),阴性似然比最低(0.226)。在服用二肽基肽酶-4(DPP-4)抑制剂的患者中,IIF显示出最高的阳性似然比(3.194)和第二低的阴性似然比(0.235):结论:在怀疑患有血脂高的老年患者不愿接受皮肤活检的情况下,IIF 是最佳的诊断方法,因为其阳性似然比最高,而阴性似然比在三种诊断方法中最低。此外,IIF还是检测使用DPP-4抑制剂患者血压的更有效工具。
A Retrospective Comparison of Diagnostic Tools of Bullous Pemphigoid for Elderly Patients.
Background: Older patients who are predisposed to bullous pemphigoid (BP) may exhibit reluctance to undergo skin biopsy due to potential complications.
Objectives: This study aimed to conduct a comparative evaluation among histology, direct immunofluorescence (DIF), and indirect immunofluorescence (IIF) to determine the optimal diagnostic tool in elderly patients.
Methods: A retrospective study was conducted on 841 patients suspected of having BP. All cases were initially classified as BP and non-BP in accordance with the diagnostic criteria. Student's t-test and chi-squared test examined differences between the 2 groups. We evaluated the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio detected by the 3 tools. We stratified the analysis by age to compare the performance of the diagnostic tools and examined the risk factors associated with BP using logistic regression.
Results: Overall, histology exhibited the highest sensitivity (89.4%), while DIF demonstrated the highest specificity (67.1%). In the elderly, the IIF test exhibited the highest specificity (57.5%), the highest positive likelihood ratio (2.047), and the lowest negative likelihood ratio (0.226). Among patients taking Dipeptidyl Peptidase-4 (DPP-4) inhibitors, IIF demonstrated the highest positive likelihood ratio (3.194) and the second-lowest negative likelihood ratio (0.235).
Conclusions: In cases that elderly patients suspected of having BP are reluctant to undergo skin biopsy, IIF demonstrates the optimal diagnostic method due to its highest positive likelihood ratio, the lowest negative likelihood ratio among the 3 diagnostic measures. Moreover, IIF is found to be a more effective tool for detecting BP in patients using DPP-4 inhibitors.
期刊介绍:
Journal of Cutaneous Medicine and Surgery (JCMS) aims to reflect the state of the art in cutaneous biology and dermatology by providing original scientific writings, as well as a complete critical review of the dermatology literature for clinicians, trainees, and academicians. JCMS endeavours to bring readers cutting edge dermatologic information in two distinct formats. Part of each issue features scholarly research and articles on issues of basic and applied science, insightful case reports, comprehensive continuing medical education, and in depth reviews, all of which provide theoretical framework for practitioners to make sound practical decisions. The evolving field of dermatology is highlighted through these articles. In addition, part of each issue is dedicated to making the most important developments in dermatology easily accessible to the clinician by presenting well-chosen, well-written, and highly organized information in a format that is interesting, clearly presented, and useful to patient care.