硬皮病相关自身抗体谱与中国系统性硬化患者临床相关性分析  

The clinical relevance of scleroderma-related autoantibodies in Chinese systemic sclerosis patients

作　　者：王迁[1] 徐东[1] 李梦涛[1] 侯勇[1] 白伊娜[1] 胡朝军[1] 宋宁[1] 赵久良[2] 张奉春[1] 赵岩[1] 曾小峰[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院风湿免疫科,100032 [2]中国医学科学院北京协和医学院北京协和医院内科,100032

出　　处：《北京医学》2010年第7期499-503,共5页Beijing Medical Journal

基　　金：国家"十一五"科技支撑计划课题(2006BAI01A07;2008BAI59B02);中华医学会临床医学科研专项资金项目(08010270105);北京协和医院青年科研基金(I604900)

摘　　要：目的分析硬皮病相关自身抗体谱[包括抗Scl-70抗体、抗RNA多聚酶Ⅲ抗体(ARA-Ⅲ)、抗着丝点抗体(ACA)和抗U1核糖核蛋白(U1RNP)抗体]与中国系统性硬化症(SSc)患者临床特征的相关性。方法前瞻性序贯纳入入选欧洲抗风湿病联盟硬皮病试验研究组(EULAR Scleroderma Trial and Research group,EUSTAR)的92例中国SSc患者,记录其临床表现和实验室检查结果,同时检测抗Scl-70抗体、ARA-Ⅲ、ACA和抗U1RNP抗体。统计分析上述自身抗体与患者各种临床特征之间的相关性。结果 92例患者中,弥漫型SSc65例,局限型SSc19例,重叠综合征6例,伴有雷诺现象的未分化结缔组织病2例。抗Scl-70抗体、ARA-Ⅲ、ACA和抗U1RNP抗体的阳性率分别为55%、13%、13%和25%。存在抗Scl-70抗体者具有较高的皮肤硬化修订Rodnan评分、免疫球蛋白(Ig)M及血小板水平,但肺动脉高压发生率、IgG水平则显著减低(P<0.05),与肺间质病变或肾危象的相关性未获证实。ARA-Ⅲ与皮肤硬化评分,毛细血管扩张,心、肺、肾脏受累等临床特点均无显著相关性。存在ACA的患者尿酸水平较高,但关节炎或关节痛症状和肺间质病变少见(P<0.05)。存在抗U1RNP抗体者肺动脉高压和心脏受累的发生率、IgG和乳酸脱氢酶水平均增高,但白细胞和血小板较低(P<0.05)。结论在SSc患者血清中检测上述硬皮病相关自身抗体有助于预测某些临床表现和脏器病变的发生。中国患者自身抗体的临床相关性可能与其他地区患者存在种族差异,值得进行更大样本的研究证实。Objective To determine the clinical relevance of scleroderma-related autoantibodies, including anti-Scl-70 antibody, anti-RNA polymeraseⅢ（ARA-Ⅲ） antibody, anti-centromere antibody （ACA） and anti-U1-nuclear ribonucleoprotein （U1RNP） antibody in Chinese systemic sclerosis （SSc） patients. Methods Ninety-two Chinese SSc patients were prospectively and consecutively registered from the clinical database of Department of Rheumatology of Peking Union Medical College Hospital, which was a part of the Scleroderma Trials And Research Group proposed by European League Against Rheumatism （EUSTAR）. Clinical features and laboratory findings were recorded. Anti-Scl-70 antibody, ARA-Ⅲ, ACA and anti- U1RNP antibody were detected. The relevance between the existance autoantibodies and clinical characteristics was analyzed statistically. Results Sixty-five diffused SSc, 19 limited SSc, 6 overlap syndrome and 2 undifferentiated connective tissue disease with positive Raynaud’s phenomenon patients were registered in this study. Anti-Scl-70 antibody, ARA- Ⅲ, ACA and anti-U1RNP antibody were detected in sera from 55%, 13%, 13% and 25% of SSc patients respectively. Patients with anti-Scl-70 antibody had a statistically significant higher modified Rodnan’s skin score, IgM level and platelet count, but statistically lower prevalence of pulmonary arterial hypertension, IgG level （P 0.05）. Association between anti-Scl-70 antibody and interstitial lung disease or renal crisis were not identified in this group of patients. This study failed to show relevance between ARA-Ⅲ and any clinical and laboratory features including modified Rodnan’s skin score, telangiectasias, cardiac, pulmonary or renal involvement. Patients with ACA had higher uric acid level but lower prevalence of arthritis/arthralgia and interstitial lung disease （P 0.05）. Patients with anti-U1RNP antibody had higher prevalence of pulmonary arterial hypertension and cardiac involvement, IgG and lactate de- hydrogenase level, however, wh

关 键 词：硬皮病 系统性硬化症 自身抗体 

分 类 号：R593.25[医药卫生—内科学] R593.241[医药卫生—临床医学]