健康体检者筛查自身抗体的临床意义  

The clinical value of autoantibody screening among healthy subjects

作　　者：李晞[1] 郑乐婷[2] 石昌荆[3] 王芃[4] 徐涓娟[1] 王健[1] LI Xi;ZHENG Le-ting;SHI Chang-jing;WANG Peng;XU Juan-juan;WANG Jian(Department of Clinical Laboratory,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi,China)

机构地区：[1]广西医科大学第一附属医院检验科,广西南宁530021 [2]广西医科大学第一附属医院风湿免疫科,广西南宁530021 [3]广西医科大学第一附属医院医疗保险科,广西南宁530021 [4]广西医科大学第一附属医院体检中心,广西南宁530021

出　　处：《广东医学》2019年第1期109-111,115,共4页Guangdong Medical Journal

基　　金：国家自然科学基金资助项目(编号:81660275);广西医科大学青年科学基金资助项目(编号:GXMUYSF201503);广西壮族自治区卫生和计划生育委员会自筹经费科研课题(编号:Z2015520)

摘　　要：目的探讨自身抗体筛查对健康体检人群的预警作用及临床意义。方法选择进行健康体检的1 157名人员,其中男性767名,女性390名,采用间接免疫荧光法(IIF)检测抗核抗体(ANA)和抗双链DNA(dsDNA)抗体,线性免疫印迹法(LIA)检测抗核抗体谱(ANAs) 12项,HITACHI 7600全自动生化分析仪检测血清C反应蛋白(CRP)和Ig亚型,MONITOR 100检测血沉(ESR),采用χ~2检验和非参数U检验进行统计学分析。自身抗体结果异常者,嘱其临床随诊。结果 1 157名健康体检者ANA阳性率为7. 35%,其中女性阳性率高于男性阳性率(12. 56%vs 4. 69%,χ~2=23. 528,P=0. 000),ANAs的总体阳性率为3. 80%,其中女性阳性率高于男性阳性率(5. 90%vs 2. 73%,χ~2=7. 055,P=0. 008)。抗dsDNA抗体及ANAs各项特异性抗体在男性和女性健康体检者中的阳性率差异无统计学意义(P> 0. 05)。自身抗体异常者每3～6个月进行1次临床随诊,最终确诊自身免疫性疾病(autoimmune diseases,AID)者14例,占1. 21%,非AID者24例,占2. 07%。确诊AID患者血清CRP、ESR结果显著高于非AID患者(P <0. 05)。结论自身抗体可在AID临床确诊前出现在患者体内,自身抗体对AID有预警作用。在健康体检中将自身抗体列入常规检查项目是非常必要和有价值的。健康体检者同时出现CRP和(或) ESR结果异常时,要警惕AID的发生。Objective To investigate the prediction and clinical significance of autoantibody screening in healthy subjects.Methods A total of 1,157 subjects were enrolled in this study,including 767 males and 390 females.IIF was applied for detection of ANA and anti dsDNA antibodies,and LIS for ANAs.Serum CRP and Ig subtypes were detected by HITACHI 7600 Automatic biochemical analyzer.ESR was detected by MONITOR 100.Chi-square test and Mann Whitney U test were used for statistical analysis.Individuals with abnormal autoantibodies were told to clinical follow-up every three months or six months.Results The positive rate of ANA was 7.35% in 852 healthy subjects,as the female positive rate was 12.56%,which was significantly higher than male positive rate( 4.69%,χ^2= 23.528,P = 0.00).The overall positive rate of ANAs was 3.8%,as the female positive rate was 5.9%,which was significantly higher than male positive rate( 2.73%,χ^2= 7.055,P = 0.008).There was no significant difference in the positive rates of anti-dsDNA antibody and ANAs specific antibodies between males and females.The final diagnosis of AID was 14 cases,and non-AID was 24 cases.The serum CRP and ESR of AID group were significantly higher than those of non-AID group( P<0.05).Conclusion Autoantibodies are typically present before the diagnosis of AID.The determinations of autoantibodies in healthy physical examination are necessary and valuable.Health subjects with CRP and/or ESR abnormalities should be screen for autoantibodies and vigilant of the occurrence of AID.

关 键 词：自身抗体 筛查实验 自身免疫性疾病 体检人群 

分 类 号：R593.2[医药卫生—内科学]