临床标本自身抗体4729例检测结果回顾性分析

Retrospective analysis of autoantibody profiles of 4729 cases

目的探讨自身抗体在临床就诊患者中的阳性分布趋势及对自身免疫性疾病(AID)的临床意义。方法采用间接免疫荧光法和酶联免疫斑点法对4 729例患者进行抗核抗体(ANA)、双链DNA抗体和ENA抗体谱检测。结果在4 279份检测标本中,ANA阳性率为12%,其中男性为5%,女性为16%,两者比较差异有统计学意义(P<0.05)。ANA阳性患者荧光模式分析表明,单一荧光模式以核斑点型(41.2%)和核均质型(18.6%)为主,混合荧光模式以核斑点/均质型(7.4%)为主。ANA阳性患者566例,选取符合AID诊断的患者322例,系统性红斑狼疮患者自身抗体阳性率抗ds-DNA抗体为51.5%,抗U1-RNP抗体为32.0%,抗Sm抗体为16.0%,抗SS-A抗体为46.0%,抗SS-B抗体为11.0%,抗Scl-70抗体为1.5%,抗rRNP抗体为12.0%。类风湿关节炎(RA)患者自身抗体阳性率抗ds-DNA抗体为6.3%,抗U1-RNP抗体为8.3%,抗Sm抗体为2.1%,抗SS-A抗体为20.8%,抗SS-B抗体为6.3%。干燥综合征(SS)患者自身抗体阳性率抗SS-A抗体为100%,抗SS-B抗体20.0%。自身免疫型肝炎(AIH)患者自身抗体阳性率抗ds-DNA抗体为8.3%,抗SS-A抗体为16.6%。强直性脊柱炎患者自身抗体阳性率抗SS-A抗体为50.0%。系统性硬皮病患者自身抗体阳性率抗Scl-70抗体为100%。肌炎/皮肌炎患者自身抗体阳性率抗Jo-1抗体为100%。混合型结缔组织病(MCTD)患者自身抗体阳性率抗ds-DNA抗体为14.0%,抗U1-RNP抗体为26.0%,抗SS-A抗体为62.0%,抗SS-B抗体为24.0%,抗Jo-1抗体为2.0%,抗rRNP抗体为2.0%。其他疾病患者中抗ds-DNA抗体和ENA抗体谱也有不同程度的阳性率。ENA抗体谱中针对7种抗原的抗体均有出现。人群中SLE、RA、AIH、MCTD患者自身抗体阳性率随年龄增加而升高。结论自身抗体的检测对AID患者诊断及鉴别诊断具有重要的意义。

Objective To explore the positive distribution trend of the autoantibodiesin outpatients and its clinical significance in patients with autoimmune disease（AID）.Methods serum samples of 4 729 patients were analyzed by testing antinuclear antibody（ANA）,anti-dsDNA antidody and ENA antibody repertoireWithindirect immunofluorescence（IFL）and enzyme linked immunodotting.Results Of the 4 729 speciemens,the positive rate of ANA was 16%,The positive rates for female patients and male patients were 12% and 5%,respectively.The positive rate in female patients was statistically higher than that in male（P0.05）.The major pure flurescence patterns of ANA were speckled pattern（41.2%）and homogenous pattern（18.6%）.The major mix fluorescence pattern was speckled pattern/homogenous pattern（7.4%）.Of the 566 anti-nuclear antibodies positive cases,three hundred and twenty-two ones with AIDS were chosen.In systemic lupus erythematosus（SLE）patients,the positive rates of anti-dsDNA antidodies,anti-U1-RNP antibodies,anti-Sm antibodies,anti-SS-A antibodies,anti-SS-B antibodies,anti-Scl-70 antibodies and anti-rRNP antibodies were 51.5%,32.0%,16.0%,46.0%,11.0%,1.5% and 12.0%,respectively.The positive rates of the antibodies mentioned above except for anti-Scl-70 antibodies and anti-rRNP antibodies in rheumatoid arthritis（RA）patients were 6.3%,8.3%,2.1%,20.8% and 6.3%,respectively.Notably,the positive rates of anti-SS-A antibodies and anti-SS-B antibodies were 100% and 20.0% in sicca syndrome（SS）patients.In autoimmune hepatitis patients,the positive rates of anti-dsDNA antidodies and anti-SS-A antibodies were 8.3%and 16.6%.The positive rate of anti-SS-A antibodies in ankylosing spondylitis（AS）patients was 50.0%.Meanwhile,the positive rate of anti-Scl-70 antibodies in progressive systemic sclerosis（PSS）and myositis/dermato myositis patients were both 100%.In mixed connective tissue disease（MCTD）patients,the positive rates of anti-dsDNA antidodies,anti-U1-RNP antibodies,anti-SS-A antibodies,anti-SS-B antibodies,anti-Jo-1 antibodies and anti-rRNP antibodies were 14.0%,26.0%,62.0%,24.0%,2.0% and 2.0%.As ages were increased,the positive rates of SLE、RA、AIH and MCTD were increased.Conclusion The autoantibodies tests have very important clinical significances for the clinical diagnosis and differential diagnosis of autoimmune diseases.