两种新型抗体联合检测在原发性干燥综合征诊断中的意义及其对脏器损害的预测价值

The diagnostic significance of combined detection of two new antibodies and their predictive value for extraglandular organ damages in patients with Sjogren's syndrome

目的研究抗毒蕈碱3受体(M3R)抗体及抗α-胞衬蛋白(α-Fodrin抗体)抗体在原发性干燥综合征(pSS)诊断中的意义及其对脏器损害的预测价值。方法检测41例pSS患者、101例非pSS结缔组织病患者及79例正常对照血清中,抗M3R抗体、抗α-胞衬蛋白抗体的分布,比较上述抗体的敏感性、特异性及联合检测的结果,并比较pSS患者中,抗SSA、抗SSB抗体及唇腺活检与上述抗体阳性率的情况。将pSS患者分为脏器受累组和无脏器受累组,分析抗体对pSS脏器受累的预测价值。结果两种抗体诊断pSS的敏感性、特异性分别为:抗M3R抗体82.9%、89.4%,抗α-胞衬蛋白抗体53.7%、78.3%;两者联合检测后,诊断pSS的特异性增高(93.3%)。抗SSA、抗SSB及唇腺活检在pSS中的阳性率分别为46.2%、28.2%和85.7%。抗M3R抗体在pSS继发肺间质纤维化,合并肝脏损伤及血液系统受累的阳性预测值分别为66.6%、60.0%及82.4%。结论抗M3R抗体及抗α-胞衬蛋白抗体在诊断pSS中具有良好的敏感性和特异性,两者联合检测可以提高诊断的特异性,抗M3R抗体对pSS脏器受累有预测价值。

Objective To study the diagnostic significance of anti-type 3 muscarinic acetylcholine receptor antibody（anti-M3R） ,anti-α-Fodrin antibody（anti-α-FA） and their combination in the diagnosis of primary Sjogren＇ s syndrome （pSS） and explore their roles in detecting extraglandular organ damages in pSS patients. Methods The diagnostic significance of anti-M3R, anti-α-FA and their combination was evaluated in pSS patients and compared with that in patients with rheumatic disorders other than pSS. The positive rate of anti-M3R,anti-α-FA was compared with those of anti-SSA, anti-SSB antibodies and labial biopsy in pSS patients. The pSS patients were divided into groups with or without organ damages. The positive predictive value of the two antibodies was calculated to determine the best one for extraglanduar organ damage in pSS. Results The sensitivity and specificity of anti-M3R and anti-α-FA were 82.9% ,89.4% and 57.3% ,78.3% ,respectively. When the two markers were combined,the specificity was raised. The positive rate of anti-SSA,anti-SSB antibodies and labial biopsy were 46.2% ,28.2% and 85.7% ,respectively. The presence of anti-M3R antibody was associated with extraglandular manifestions such as pulmonary fibrosis,hepatic lesion and hematological involvement. Conclusion Anti-M3R and anti-α-FA are useful serologic parameters in the diagnosis of pSS. Their combination detection can increase significantly the diagnostic specificity. Anti-M3R antibody is associated with extraglandular organ damages in patients with pSS.