联合检测3种肌炎特异性自身抗体在皮肌炎诊断中的意义  

Clinical significance of combined detection of three myositis-specific autoantibodies in the diagnosis of dermatomyositis

作　　者：吴云娟[1] 张晓军[1] 张缪佳[1] 

机构地区：[1]南京医科大学第一附属医院风湿免疫科,南京210029

出　　处：《临床检验杂志》2013年第6期422-424,共3页Chinese Journal of Clinical Laboratory Science

基　　金：江苏省人民医院临床诊疗新技术项目

摘　　要：目的测定皮肌炎(DM)患者血清中的肌炎特异性抗体(MSAs),探讨MSAs在诊断DM中的价值。方法采集38例DM、14例多发性肌炎、20例其他结缔组织病患者(6例干燥综合征、7例SLE、4例系统性硬化症、3例类风湿关节炎)和24例健康人对照血清。用ELISA法检测患者血清中抗临床无肌病性皮肌炎-140(CADM-140)抗体、抗蛋白155/140(P155/140)抗体及抗小泛素样修饰酶(SAE)抗体,分析抗体阳性率及与患者临床表现间的关系。结果 38例DM患者中抗CADM-140抗体阳性4例(10.5%),患者多表现发热、Gottron征、肺间质病变(ILD)及活动后气喘;抗P155/140抗体阳性4例(10.5%),患者主要表现Gottron征、Heliotrope征、ILD、吞咽困难及肿瘤;抗SAE抗体阳性3例(7.9%),患者主要表现Gottron征、关节炎/痛及吞咽困难。3项抗体联合检测的敏感性、特异性、阳性预测值、阴性预测值及Youden指数分别为28.9%、100%、100%、68.2%和0.289。结论联合检测抗CADM-140抗体、抗P155/140抗体及抗SAE抗体可提高DM诊断的特异性,对于DM的鉴别诊断有重要意义。Objective To detect the myositis-specific autoantibodies （MSAs） in serum samples from the patients with dermatomyositis （DM） , and evaluate their values in the diagnosis of DM. Methods Serum samples were collected from 24 healthy persons, 38 patients with DM, 14 with polymyositis and 20 with other connective tissue diseases, including 6 cases of Sjogren＇s syndrome, 7 systemic lupus erythematosus, 4 systemic sclerosis and 3 rheumatoid arthritis. Then, the anti-CADM （clinically amyopathic dermatomyositis）-140 antibody, anti-P155/140 antibody, and anti-SAE （small ubiquitin-like modifier enzyme） antibody in these serum samples were determined by enzyme-linked immunosorbent assay （ ELISA）, and the positive rates of these antibodies and their correlation with patients＇ clinical manifestation were analyzed. Results The anti-CADM-140 antibody was detected from 4 out of 38 （ 10.5% ） patients with DM, and the patients were characterized by fever, Gottron syndrome, interstitial lung disease （ILD） and exercise-induced asthma. The anti-P155/140 antibody was also detected from 10.5% of patients with DM, who were characterized by Gottron syndrome, Heliotrope rash, ILD, dysphagia and malignancies. Three out of 38 （7.9%） DM patients were positive for anti-SAE antibody and were characterized by Gottron sign, myalgia, arthritis, arthralgia and dysphagia. When 3 antibodies were combined for the diagnosis of DM, the sensitivity, specificity, positive predictive rate, negative predictive rate and Youden index were 28.9%, 100% , 100% , 68.2% and 0.289, respectively. Conclusion The combined detection of anti-CADM-140 antibody, anti-P155/140 antibody and anti-SAE antibody may increase the diagnosis specificity of DM, and also help to improve the differential diagnosis of DM.

关 键 词：皮肌炎 抗CADM-140抗体 抗P155 140抗体 抗SAE抗体 

分 类 号：R446.6[医药卫生—诊断学] R593.26[医药卫生—临床医学]