四种自身抗体在原发性干燥综合征诊断中的合理应用

The application of combined detection of autoantibodies in primary Sjogren＇s syndrome

目的通过检测SSA抗体、SSB抗体、M3受体蛋白多肽（M3RP）抗体、α-胞衬蛋白IgG抗体在原发性干燥综合征（pSS）的敏感性与特异性，分析4种抗体在pSS诊断中的应用价值。方法选pSS患者110例，类风湿关节炎（RA）患者80例，系统性红斑狼疮（SLE）患者80例，用斑点法检测所有患者的SSA抗体、SSB抗体，ELISA法检测所有患者的M3RP抗体、α-胞衬蛋白IgG抗体。结果M3RP抗体、α-胞衬蛋白IgG抗体、SSA抗体、SSB抗体在pSS患者中的敏感性分别为78．2％、77．3％、45．5％、30．9％，均高于RA（6．2％、10．0％、6．2％、0）和SLE患者（9．9％、11．3％、28．8％、5．0％）（P值均小于0．05）。SSA抗体、SSB抗体、M3RP抗体、α-胞衬蛋白IgG抗体在pSS患者中的特异性分别为83．8％、97．7％、92．0％、90．0％。M3RP抗体、α-胞衬蛋白抗体在SSA抗体和（或）SSB抗体阴性的pSS患者中的阳性率分别为66．1％、69．5％。SSA抗体或SSB抗体联合M3RP抗体或α-胞衬蛋白抗体，可使pSS诊断的敏感性提高至88．2％，α-胞衬蛋白抗体、M3RP抗体联合检测时敏感性达83．6％。2种抗体联合检测与3种抗体联合检测比较，其对诊断的敏感性、特异性无统计学意义。结论SSA抗体或SSB抗体联合M3RP抗体和（或）α-胞衬蛋白抗体检测，可明显提高pSS诊断的敏感性。SSB抗体、M3RP抗体、α-胞衬蛋白IgG抗体在pSS诊断中均有较高的特异性。

Objective To compare the specificity and sensitivity of antibodies against SSA and SSB, anti-M3 receptor polypeptide antibodies, anti-α-fodrin （IgG）antibodies in primary Sjogren＇s syndrome （pSS）. Methods One hundred and ten pSS patients （mean age was 49.2 ± 14. 8, mean disease duration was 5. 6 ± 4.6）, 80 systemic lupus erythmatosis （ SLE ） patients （ mean age was 25. 5 ± 4. 6, mean disease duration was 2. 5 ± 1.2） and 80 rheumatoid arthritis（RA） patients（mean age was 44. 6 ±3.5,mean disease duration was 4. 2 ± 1.1 ） were studied. Enzyme-hnked immunosorbent assay was used to measure these antibodies. Results The seropositive rates of anti-SSA, anti-SSB antibodies, anti-M3 receptor polypeptide antibodies and anti-α-fodrin （IgG） antibodies were 45. 5%, 30. 9%, 78.2% and 77. 3%, respectively in pSS. They were much higher than those in RA and SLE patients （ P 〈 0. 05 ）. Specificities of SSA, SSB antibodies,anti-M3 receptor antibodies and anti-α-fodrin IgG were 83. 8% ,97.7% ,92.0% and 90. 0% respectively. With the combination of these antibodies in the diagnosis of pSS, the sensitivity can be increased at least to 88.2% and the specificity was not decreased significantly. Conclusion Combination of these antibodies can significantly improve the sensitivity of these antibodies in the diagnosis of pSS. Anti-SSA and SSB antibodies, anti-M3 receptor antibodies and anti-α-fodrin（IgG） antibodies are specific antibodies for the diagnosis of pSS.