肌炎特异性抗体在多发性肌炎和皮肌炎中的意义  

The clinical significance of myositis specific autoantibodies in polymyositis and dermatomyositis

作　　者：谢瑶[1] 卢昕[1] 王国春[1] 

机构地区：[1]北京中日友好医院风湿免疫科,100029

出　　处：《中华风湿病学杂志》2005年第11期645-649,共5页Chinese Journal of Rheumatology

基　　金：国家自然科学基金资助项目(30170885);北京中日友好医院2005年重点学科基金资助项目

摘　　要：目的测定多发性肌炎(PM)/皮肌炎(DM)患者血清中肌炎特异性抗体(MSA)及肌炎相关性抗体(MAA)的阳性率,探讨MSA在PM/DM中的意义。方法PM/DM患者31例,用免疫印迹法检测血清MSAs和MAAs阳性率,分析患者的临床表现及预后与自身抗体的相关性。结果31例患者中18例出现MSAs和/或MAAs阳性(58%),其中MSAs阳性率为39%,最常见的MSAs是抗Jo-1抗体(29%),其次是抗Mi-2抗体(6%),抗PL-7抗体(3%),抗PL-12抗体(3%),MAAs的阳性率为32%,其中抗Ku-72占16%,抗Ku-86占23%,抗PM-Scl抗体占6%。肺间质病变及关节炎/痛在抗Jo-1抗体阳性患者中的比例明显高于抗Jo-1抗体阴性组(P<0.05)。治疗后18例患者完全缓解,12例部分缓解,1例死亡。随访12例患者,在激素减量后均有复发,MSAs阳性与阴性组间复发次数、病死率无明显差别。肺间质纤维化在MSAs阳性患者中发生率较高,预后较差。结论MSAs和MAAs在PM/DM患者中阳性表达率较高,MSAs与PM/DM的临床表现和预后相关。开展MSAs及MAAs的测定对于PM/DM临床诊断和治疗有重要意义。Objective To detect the prevalence of myositis-specific autoantibodies （MSAs） and myositis-associated autoantibodies （MAAs） in patients with polymyositis （PM） and dermatomyositis （DM）, and analyse the correlation between MSAs and the clinical features and prognosis of PM/DM. Methods Serum samples, of 31 PM and DM patients were screened for MSAs （including anti Jo-1, anti Mi-2, anti PL-7, anti PL-12 antibodies） and MAAs （including anti Ku, anti PM-Scl antibodies） by immunoblotting test. Results Serum MSAs/ MAAs were detected in 18 out of 31 PM/DM patients （58%）. MSAs were present in 12 patients （39%）. The most frequently encountered MSAs was anti-Jo-1 autoantibody （29%）, followed by anti-Mi-2 （7%）, anti-PL-7 （3%）, and anti-PL-12 （3%）. MAAs were present in 10 patients （32%）, including anti-Ku-72 （16%）, anti-Ku-86 （23%） and anti-PM/Scl （7%）. Notably, anti-Jo-1 antibody was closely associated with interstitial lung disease （ILD） and arthritis/arthralgia compared with the anti-Jo-1 antibody negative patients （P〈0.05）. Treatment of corticosteroid plus immunosuppressive drugs was effective in achieving complete remission in 18 patients and partial regnission in 12 patients, but relapse was frequent during follow-up ,（1-12 years）. The relapse frequency and mortality were similar between MSAs positive and negative groups. The incidence of ILD was significantly increased in MSAs positive patients with a poor prognosis. Conclusions Our data indicate that the prevalence of MSAs and MAAs are high in PM/DM patients. MSAs are associated with clinical features and prognosis in patients with PM and DM. The determination of MSAs/MAAs has important implication for clinical diagnosis and treatment of PM and DM.

关 键 词：多发性肌炎 皮肌炎 免疫印迹法 特异性抗体 多发性肌炎 皮肌炎 阳性患者 抗JO-1抗体 肺间质纤维化 预后相关 临床表现 完全缓解 

分 类 号：R593.26[医药卫生—内科学]