不同抗体检测对风湿病性葡萄膜炎的诊断价值  

The value of different antibodies detection in diagnosis of rheumatism with uveitis

作　　者：许晓风[1] 张举[2] 崔莉[3] 王艳红[4] 岳燕[1] 迟林[1] 白婕[1] 李昊淼[1] 鲁辛辛[1] 

机构地区：[1]首都医科大学附属北京同仁医院检验科,100730 [2]首都医科大学附属北京同仁医院眼科,100730 [3]首都医科大学附属北京同仁医院风湿免疫科,100730 [4]中国医学科学院基础医学研究所流行病学与卫生统计学系

出　　处：《中华医学杂志》2017年第4期285-290,共6页National Medical Journal of China

摘　　要：目的探讨人类白细胞B27抗原（HLA—B27）、抗核抗体（ANA）、抗双链DNA抗体（anti-dsDNA）和抗中性粒细胞胞质抗体（ANCA）检测对风湿病性葡萄膜炎的诊断价值。方法连续收集2012年3月至2016年3月就诊于北京同仁医院且长期生活于北京及其周边地区的初诊非感染性葡萄膜炎患者724例，检测患者外周血淋巴细胞HLA—B27抗原表达和血清中ANA、anti—dsDNA和ANCA表达情况，并通过收集详细临床资料，结合影像学和病理学检查等明确葡萄膜炎患者是否患有风湿病及风湿病类型。结果724例初发非感染性葡萄膜炎患者中，共确诊风湿病性葡萄膜炎285例（占39．4％）；其中男135例，占47．4％，女150例，占52．6％；男性患者的平均年龄为（41±14）岁，低于女性患者的平均年龄（44±14）岁，差异有统计学意义（t=2．18，P〈0．05）。285例风湿病性葡萄膜炎包括176例脊柱关节炎性葡萄膜炎、48例原发性系统性血管炎性葡萄膜炎、22例系统性红斑狼疮性葡萄膜炎、18例原发性干燥综合征性葡萄膜炎、16例类风湿性关节炎性葡萄膜炎、5例幼年性特发性关节炎性葡萄膜炎。风湿病性葡萄膜炎患者HLA-B27（57．2％）、ANA（15．8％）、anti—dsDNA（5．3％）和ANCA（9．1％）的阳性率明显高于非风湿病性葡萄膜炎患者HLA—B27（1．1％）、ANA（1．6％）、anti．dsDNA（0）和ANCA（0．9％）的阳性率，差异均有统计学意义（Fisher精确概率检验，P均〈0．01）；HLA—B27抗原阳性主要表现在脊柱关节炎性葡萄膜炎患者，阳性率为92．1％；ANA阳性主要表现在系统性红斑狼疮性葡萄膜炎患者，阳性率为95．5％；anti-dsDNA阳性主要表现在系统性红斑狼疮性葡萄膜炎患者，阳性率为59．1％；ANCA阳性主要表现在原发性系统性血管炎性葡萄膜炎患者（除外白塞病），阳性率为57．1％。结论HLA-B27抗原、ANA、antiObjective To investigate the value of HLA-B27 antigen, antinuclear antibody （ANA）, anti-dsDNA and Anti-Neutrophil Cytoplasmic Antibodies （ANCA） detection in diagnosis of rheumatism with uveitis. Methods Seven hundred and twenty four newly diagnosed patients with non-infection uveitis in Beijing Tongren Hospital from March 2012 to March 2016 who long-term lived in Beijing and its surrounding areas were continuously enrolled. HLA-B27 antigen expressions in peripheral blood lymphocytes and ANA, anti-dsDNA and ANCA levels in serum were tested. The detailed clinical data, imaging examinations and pathological examinations were recorded to define whether the patients had rheumatism and the types of rheumatism. Results There were 285 patients were diagnosed with rheumatism in 724 patients （39.4%） , with 135 male （47.4%） and 150 female （52. 6% ）. The mean age of male （41 ± 14） was lower than that of female （44 ± 14 ）, with statistically significant （ t = 2. 18, P 〈 0. 05 ）. There were 176 patients with Spondyloarthropathies, 48 patients with primary systemic vasculitis, 22 patients with systemic lupus erythematosus, 18 patients with primary Sjogren＇s syndrome, 16 patients with rheumatoid arthritis and 5 patients with juvenile idiopathic arthritis in 285 rheumatism patients. The positive rate of HLA-B27 （57.2%）, ANA（ 15.8% ）, anti-dsDNA （5.3%） and ANCA（9. 1% ） in rheumatic uveitis patients were obviously higher than those of non-rheumatic uveitis patients [ HLA-B27 （ 1. 1% ） , ANA （ 1.6% ） , anti-dsDNA （0. 0% ） and ANCA（0. 9% ）] , with statistically significant （Fisher＇s exact test, P 〈0. 01 ）. The HLA-B27 positive antigen were mainly in patients with Spondyloarthropathies, rate was 92. 1% ; the positive ANA were mainly in patients with systemic lupus erythematosus, rate was 95.5% ; the positive anti-dsDNA were mainly in patients with systemic lupus erythematosus, rate was 59. 1% ; the positive ANCA were mainly in patients with primary systemic

关 键 词：葡萄膜炎 抗原 抗体 诊断 

分 类 号：R773.9[医药卫生—眼科]