特异性抗膜突蛋白抗体在结缔组织病肺部受累早期诊断中的意义

Specific anti-moesin antibodies can predict associated connective tissue diseases pulmonary involvement

目的探讨特异性的自身抗体对结缔组织病（CTD）相关肺部损伤的临床意义。方法以重组膜突蛋白作为抗原，应用酶联免疫吸附试验（ELISA）和免疫印迹法检测40例系统性硬化症（SSc）患者和38例混合性结缔组织病（MCTD）患者外周血抗膜突蛋白抗体。比较不同肺脏受累的CTD患者之间抗膜突蛋白抗体的差异。结果ELISA和免疫印迹法检测发现21例（52％）SSc患者和15例（39％）MCTD患者抗膜突蛋白抗体阳性。CTD合并肺脏受累组抗膜突蛋白抗体的滴度均显著高于无肺脏受累组（0．23±0．14与0．12±0．35，P=-0．001）。在肺功能检查方面，抗膜突蛋白抗体阳性患者组与阴性患者组比较，肺总量[（82±10）％与（90±14）％，P=0．027]，用力肺活量[（76±13）％与（85±17）％，P=0．040]，一氧化碳弥散量[（58±16）％与（72±23）％，P=0．014]均出现显著降低。结论抗膜突蛋白抗体在SSc和MCTD患者中具有较高的阳性率，并与CTD合并肺脏受累显著相关，可能早期提示结缔组织病肺脏损害。

Objective Immune and inflammatory mechanisms could play a significant role in genesis or progression of interstitial lung disease and pulmonary arterial hypertension, especially in patients with connective tissue diseases. Specific antibodies may predict the occurrence of this condition. Methods The plasma of patients with systemic sclerosis （SSc） or mixed connective tissue disease （MCTD） were screened with enzyme linked immunosorbent assay （ELISA） and Western blotting using recombinant moesin. The clinical data were recorded and pulmonary function tests （PFI^s） were performed in 78 consecutive individuals in order to identify the difference in clinical manifestations between anti-moesin positive group and negative group. Results Our results showed high titers of anti-moesin antibodies in 21 （53%） of 40 patients with SSc, and 15 （39%） of 38 patient with MCTD. The presence of anti-moesin antibodies was significantly correlated with pulmonary involvement （ILD and PAH） in SSc and MCTD patiens （P=0.001）. Comparing with the antibody negative group, the total lung capacity[ （82±10）% vs （90±14）%, P=0.027）, forced vital capacity [ （76±13）% vs （85±17）%, P=0.040] and diffu-sing capacity of the lung for carbon monoxide [ （58±16）% vs （72±23）%, P=0.014] of PFTs in anti-moesin antibodies positive group were noted to be significantly decreased （P〈0.05）. Conclusion Specific antibodies to moesin is prevalent in patients with SSc and MCTD, so it may be an early predictor of pulmonary involvement in patients with SSc or MCTD.