The sample size in this study consisted of 103 pemphigus patients and 125 healthy individuals who were matched regarding their sex (p-value = 0.87), age (p-value = 0.67) and BMI (p-value = 0.07). The healthy cases had a mean age of 48 ± 12.8. The mean of age for cases was 48.7 ± 12.9 (Range: 18-77, Median 51). The average duration of disease was 46.7 ± 49.5 months (Range: 1-200 months).
3.1. Evaluation of Indexes in Pemphigus patients
In addition to routine corticosteroid therapy, the applied adjuvant treatments in pemphigus patients were as the following: 46.6% (48 individuals) received Rituximab and 14.6% (15 individuals) Mycophenolate Mofetil, 4.9% (5 individuals) Methotrexate, 2.9% (3 individuals) Azathioprine and 31.2% (32 individuals) were treated with no other adjuvant drugs. The mean cumulative dose for steroids was recorded as 14.6 ± 16 gr.
Evaluating other target indexes, our results showed that pemphigus patients had a PDAI of 6.86 ± 11, desmoglein 1 of 76.1 ± 83 and desmoglein 3 of 111.5 ± 82. Phase angle, PBF and VFA were recorded as 5.72 ± 0.81, 38.36 ± 10, 147.32 ± 54, respectively. At last, it was indicated that the patients had a sarcopenic index of 7.63 ± 3.9.
Evaluation of the correlations between PDAI, steroid cumulative doses, phase angle and sarcopenic index in all patients revealed that there was only a significant correlation between phase angle and sarcopenic index (Spearman rho = 0.689, P<0.001). Moreover, studying the correlation between steroid dose and other assessed factors, it was revealed that steroid dose had a significant correlation with PDAI (Spearman rho = (-) 0.408, P<0.001), desmoglein 1 (Spearman rho = (-) 0.335, P=0.001) and desmoglein 3 (Spearman rho = (-) 0.199, P=0.044) and sarcopenia index (Spearman rho = (-) 0.214, P=0.030); while steroid dose had no correlation with VFA, BMI, volume load, PBF, cumulative steroid dose or phase angle (P>0.05).
Based on our finding there was no significant correlation between gender and type of adjuvant therapy and duration of treatment in this study (P>0.05). Cumulative doses of steroids were similar between both genders (P=0.34), the volume load was significantly lower in males (P=0.03), phase angle and sarcopenic index were both significantly higher in males compared to females (P<0.001) and females had a significantly higher BMI (P=0.017). However, there was no significant difference in PDAI, desmoglein 1 and 3, and age between sexes (P>0.05). Moreover, PBF and VFA were significantly higher in females compared to males (P<0.001) (Table 1).
Table 1
Comparison of indexes between different sexes and treatment durations
Index
|
Gender
|
Time
|
female
|
male
|
P-value*
|
More than 6 Months
|
Less than 6 Months
|
P-value*
|
cumulative dose
|
13.85 (±15.32)
|
16.15 (±17.69)
|
0.347
|
17.14 (±16.63)
|
2.65 (±1.95)
|
<0.001
|
Phase angle
|
5.04 (±0.68)
|
5.75 (±0.85)
|
<0.001
|
5.28 (±0.84)
|
5.22 (±0.64)
|
0.862
|
Sarcopenic Index
|
6.82 (±1.14)
|
9.28 (±6.42)
|
<0.001
|
7.74 (±4.32)
|
7.11 (±0.68)
|
0.670
|
Volume load
|
0.065 (±0.56)
|
-0.08 (±0.55)
|
0.035
|
-0.01 (±0.59)
|
0.14 (±0.35)
|
0.527
|
PDAI
|
7.59 (±13.25)
|
5.38 (±7.65)
|
0.895
|
4.68 (±9.36)
|
17.17 (±15.90)
|
0.001
|
desmoglein 1
|
75.35 (±83.47)
|
77.62 (±84.47)
|
0.860
|
66.74 (±78.8)
|
120.32 (±92.37)
|
0.013
|
desmoglein 3
|
107.09 (±82.45)
|
120.7 (±84.01)
|
0.438
|
96.28 (±80.81)
|
183.84 (±46.46)
|
<0.001
|
BMI
|
28.59 (±4.69)
|
26.28 (±4.63)
|
0.017
|
27.76 (±4.93)
|
28.15 (±4.08)
|
0.460
|
age
|
47.84 (±12.89)
|
48.53 (±13.35)
|
0.551
|
48.66 (±12.99)
|
45.28 (±12.92)
|
0.368
|
PBF
|
43.44 (±6.41)
|
28.05 (±8.55)
|
<0.001
|
38.02 (±10.52)
|
39.97 (±8.55)
|
0.561
|
VFA
|
167.36 (±43.14)
|
106.66 (±53.16)
|
<0.001
|
145.82 (±55.73)
|
154.43 (±49.58)
|
0.633
|
PDAI, pemphigus disease area index; BMI, body mass index; PBF, percent body fat; VFA, visceral fat area |
Patients who were treated for less than six months had a significantly higher PDAI (P = 0.001), desmoglein 1 (P=0.013) and desmoglein 3 (P<0.001) and a significantly lower cumulative dose of steroids (P<0.001) compared to those treated for more than 6 months (Table 1). Moreover, there was significant reverse Spearman´s correlation between age and Phase angle (r = -0.399, P<0.001), sarcopenic Index (r= -0.263, P=0.007), cumulative steroid dose (r= -0.266, P=0.007) and volume load (r= -0.218, P=0.027).
In order to assess the effect of adjuvant treatments, there was a significant difference between patients receiving rituximab, other adjuvant therapies and no adjuvant therapy regarding age (P=0.002), PDAI (P=0.011) and cumulative steroid dose (P=0.018). In addition, our results indicated that patients treated with rituximab received a significantly lower cumulative dose of steroids (P=0.002), and their age (P=0.002) and PBF (P=0.04) were significantly lower, while they had a significantly higher sarcopenic index (P=0.02) and higher volume loads (P=0.04) compared to patients receiving other adjuvant treatments. However, there was no significant difference regarding phase angle, PDAI, desmoglein 1 and 3, VFA and BMI (P>0.05).
Finally data revealed that there was a significant Spearman´s correlation between phase angle and sarcopenic index (r= 0.689, P<0.001), PBF (r= - 0.411, P<0.001), and VFA (r =-0.283, P=0.004). Further, PBF had significant reverse relation with sarcopenic index (r= -0.307, P=0.002) in pemphigus patients.
3.2. Comparison of pemphigus patients to control group
The differences of indexes between the case and control groups were also evaluated in this study. Based on the obtained results from student’s t test, except for the VFA (P=0.021) and PBF(P=0.031), there was no significant difference between case and control groups in other indexes. In this regard, the results revealed that compared to healthy controls, PV patients had a significantly higher VFA (147.32 vs 131.06) and PBF (38.36 vs 35.63). Further details on the comparison of PV cases and healthy participants is demonstrated in Table 2. Moreover, patients who were affected by PV below one year duration (N=40) were also compared with healthy controls. Interestingly, similar results were obtained where there was only a significant difference between these patients and the control group regarding their VFA (153.54 vs 131, P = 0.017) and PBF (39.42 vs 35.63, P = 0.022).
Table 2
Comparison of Indexes between Pemphigus vulgaris patients and healthy subjects
Index
|
group
|
Mean
|
Std. Deviation
|
P-value
|
age
|
control
|
48.79
|
12.86
|
0.674
|
case
|
48.07
|
12.98
|
BMI
|
control
|
26.74
|
4.42
|
0.077
|
case
|
27.83
|
4.77
|
Phase angle
|
control
|
5.27
|
0.83
|
0.958
|
case
|
5.27
|
0.81
|
Sarcopenic index
|
control
|
7.16
|
1.21
|
0.488
|
case
|
7.28
|
1.29
|
VFA
|
control
|
131.06
|
50.8
|
0.021
|
case
|
147.32
|
54.57
|
BCM
|
control
|
29.79
|
6.07
|
0.957
|
case
|
29.74
|
7.28
|
ECW
|
control
|
13.08
|
2.61
|
0.987
|
case
|
13.09
|
2.93
|
ICW
|
control
|
20.80
|
4.24
|
0.842
|
case
|
20.68
|
5.03
|
TBW
|
control
|
33.89
|
6.81
|
0.859
|
case
|
33.71
|
8.00
|
PBF
|
control
|
35.63
|
8.76
|
0.031
|
case
|
38.36
|
10.19
|
BMI, body mass index; VFA, visceral fat area; BCM, body cell mass; ECM, extracellular mass; ICW, intracellular mass; TBW, total body water; PBF, percent body fat; |