1801例抗核抗体检测结果及其临床分析

Clinical analysis of 1801 cases detected antinuclear antibodies

目的探讨抗核抗体(ANA)的流行病学特征及其与临床的相关性。方法回顾性分析1801例ANA检测结果及其临床资料。结果 (1)ANA阳性604例,总阳性率为33.5%,其中82.5%为女性患者。60岁以下各年龄组女性患者阳性率均高于男性(P<0.05),而以36～45岁组阳性率最高。(2)ANA荧光模型以细胞核型荧光(67.4%)最常见,以核颗粒型(43.7%)为主。(3)ANA阳性患者特异性抗体总阳性率为47.8%。混合型特异性抗体阳性率最高(57.8%),细胞浆型(12.7%)最低(P<0.01)。抗核点型、抗核膜型、抗着丝点型及抗中心粒抗体阳性患者均未检出特异性抗体。(4)ANA阳性者66.2%诊断为自身免疫性疾病(AID),显著高于ANA阴性者(17.0%),差异有统计学意义(P<0.01)。混合型ANA组73.6%诊断为AID,其次为细胞核型ANA组(70.2%),最低为细胞浆型ANA组(36.9%),后者与前两组比较,差异有统计学意义(P<0.01)。系统性红斑狼疮(SLE)组ANA阳性率最高。SLE、类风湿关节炎(RA)、混合结缔组织病(MCTD)、系统性硬皮病(SS)、多发性肌炎(PM)/皮肌炎(DM)、重叠组织病患者ANA阳性率与非AID患者比较,差异有统计学意义(P<0.05),而强直性脊柱炎(AS)、成人斯蒂尔病(STILL)患者与非AID患者比较,差异无统计学意义。SLE、RA、MCTD患者ANA模型均以核颗粒型为主。滴度达1:3200者89.1%诊断为AID,其次为滴度达1:1000者(72.2%)与滴度达1:320者(44.7%),3组间比较,差异均有统计学意义(P=0.000)。结论不同性别和年龄患者ANA阳性率存在差异;ANA存在多种荧光模型,不同荧光模型ANA阳性患者特异性抗体检出率存在差异,部分ANA阳性患者不能检测出特异性抗体;高滴度ANA对于AID诊断有重要意义,但ANA荧光模型对不同AID疾病的诊断无特异性。

Objective To study the epidemiological characteristics of antinuclear antibodies（ANA） and its association with autoimmune diseases（AID）.Methods Detected results of ANA and clinical data in 1 801 cases were analyzed.Results（1）604 cases（33.5%） were positive with ANA,of which 82.5% were female patients.In patients equal with or less than 60 years old,the positive rates were significantly higher in female patients than in male patients,and the positive rate reached the highest level patients of 36-45 years old.（2）The major ANA fluorescence pattern was antinuclear speckled pattern（43.7%）.（3）In patients positive with ANA,the positive rate of specific antibodies was 47.8%.The detection rate of specific antibodies with mixed pattern was the highest（57.8%）and the anticytoplasmic pattern was the lowest（12.7%）（P〈0.01）.Specific antibodies could not be identified in patients positive with antinucleolinus,antinuclear membrane,anticentriole and anticentromere pattern.（4）66.2% of ANA-positive patients,yet only 17.0% of ANA-negative patients,were diagnosed as AID（P〈0.01）.73.6% of the mixed pattern group,70.2% of antinuclear pattern group and 36.9% of the anicytoplamic pattern group were diagnosed as AID（P〈0.01）.The positive rate of ANA was significantly higher in systemic lupus erythematosus（SLE） group.Positive rates of ANA in groups of SLE,rheumatoid arthritis（RA）,mixed connected tissue disease（MCTD）,systemic scleroderma（SS）,polymyositis（PM）/dermatomyositis（DM） and overlap syndrome were statistical different with patients without AID（P〈0.05）,whereas there was no statistical difference between ankylosing spondylitis（AS） and Still disease（STILL） patients and patients without AID.The major ANA pattern in SLE,RA and MCTD patients was antinuclear speckled pattern.In patients with ANA titer at least 1：3 200,89.1% were with AID,the ratios were 72.2% and 44.7% in patients with ANA titer at least 1：1 000 and 1：320,and the ratios were statistically different between the there groups（P=0.000）.Conclusion The positive rate of ANA in patients of different genders and ages might be different.There could be several fluorescence patterns of ANA,and the detection rate of specific antibodies in patients with different patterns of ANA was different.Specific antibodies could not be identified in part of ANA-positive patients.ANA,especially of high titer,could have great value for diagnosis of AID,but the patterns of ANA were not specific for diagnosis of various AID.