抗核抗体及抗体谱在常见关节疾病中的临床表达特征分析

Characteristic analysis of the clinical expressions of antinuclear antibody and antibody profiles in common joint diseases

目的探讨抗核抗体(antinuclear antibody,ANA)及抗核抗体谱(antinuclear antibody spectrum,ANAs)检测在常见关节疾病诊断中的临床意义。方法回顾性分析我院2013年1月至2014年10月452例关节疾病患者的临床资料,根据临床诊断分为骨关节病组63例,类风湿性关节炎(rheumatoid arthritis,RA)组291例,痛风性关节炎组98例。分析ANA及ANAs在不同疾病组中的分布情况,并分析ANA荧光型及ANAs不同抗体组合在各疾病组中的表达情况,对检测结果进行统计学分析。结果(1)452例患者中,170例患者ANA+(37.6%,170/452),88例患者ANA+/ANAs+(19.5%,88/452),82例患者ANA+/ANAs-(18.1%,82/452),未见ANA-/ANAs+,经Chisq卡方检验,ANA与ANAs的检测结果差异有统计学意义(χ2=177.98,P=0.000)。(2)63例骨关节病患者中18例ANA+(28.6%,18/63),共发现6种荧光型,其中胞浆型最多(44.4%,8/18);291例RA患者中146例ANA+(50.2%,146/291),共发现13种荧光型,其中以均质型最多(32.2%,47/146);98例痛风性关节炎患者中6例ANA+(6.1%,6/98),共发现5种荧光型,均不多于2例;不同疾病组间ANA阳性率差异有统计学意义(P=0.000)。斑点、胞浆、均质、斑点胞浆、均质斑点及均质胞浆6种荧光型在不同疾病组中分布差异有统计学意义(χ2=21.43,P=0.018)。(3)63例骨关节病患者中6例ANAs+(9.5%,6/63),共有6种抗体阳性;291例RA患者中78例ANAs+(26.8%,78/291),共有10种抗体阳性,以Anti Ro60、Anti Ro52、Anti U1n RNP及AntiSSB多见;98例痛风性关节炎患者中4例ANAs+(4.1%,4/98),共有3种抗体阳性;ANAs阳性率在不同疾病组中差异有统计学意义(P=0.000);在所有ANAs+中共发现31种ANAs+组合,其中骨关节病患者组中有5种ANAs+组合,RA患者组中共有29种ANAs+组合,痛风性关节炎患者组中有3种ANAs+组合,其中Anti Ro52/Anti Ro60/Anti SSB、Anti Ro52、Anti Ro52/Anti Ro60、Anti Ro60及Anti U1n RNP均至少在2种或以上疾病中出现;(4)同一ANA荧光型在不同疾病中可以观察到不同ANAs阳性组合。结论ANA与ANAs的检测结果有一定相关性,但无法依靠ANA荧光型推断ANAs的特异性抗体表达情况;ANA不同荧光型及ANAs不同的阳性组合可为疾病诊疗过程提供重要参考;ANA及ANAs在RA中表达的多样性及复杂程度可为该病的诊疗提供更多有价值的参考。

Objective To explore the clinical significance of antinuclear antibody（ANA） and antinuclear antibody spectrum（ANAs） detecting in the diagnosis of common joint diseases. Methods The clinical data of 452 cases patients with joint disease in our hospital from January 2013 to October 2014 were collected and retrospectively analyzed. The patients were divided into osteoarthropathy group 63 cases, rheumatoid arthritis（RA） group 291 cases and gouty arthritis group 98 cases according to the clinical diagnosis. The distributions of ANA and ANAs in different disease groups were analyzed respectively. The different expression combinations of ANAs among different diseases, as well as the differential expressions of the ANA fluorescent types among different disease groups were further analyzed. The results were analyzed statistically. Results（1）There was 170 cases（37.6%,170 / 452） patients showed ANA ＋, 88 cases（19.5%,88 / 452） ANA ＋ /ANAs＋, 82 cases（18.1%,82 / 452） ANA＋ / ANAs-, and no ANA- / ANAs＋ was found among 452 cases patients. There was statistical significance in the difference of ANA and ANAs results（χ^2= 177.98, P= 0.000）.（2）There were 18 cases（28.6%,18 / 63） patients with osteoarthropathy showed ANA＋, and found 6 kinds fluorescent types, of which cytoplasm was the most（44.4%,8 / 18）; There were 146 cases（50.2%,146 / 291） patients with RA showed ANA＋, and found 13 kinds fluorescent types, of which the homogeneous type（32.2%,47 / 146） was the most; There were 6 cases（6.1%,6 / 98） patients with gouty arthritis showed ANA ＋, and found 5 kinds fluorescent types, all of which appeared in no more than 2 cases; There was statistical significance in the ANA positive rate among three joint disease groups（P = 0.000）, and some fluorescent types of ANA were associated with different joint diseases（χ2= 21.43, P= 0.018）.（3）There were 6 cases（9.5%,6 / 63）patients with osteoarthropathy showed ANAs＋, and found 6 kinds antibodies. There were 78 cases（26.8%,78 /291） patients with RA showed ANAs＋, and found 10 kinds antibodies. There were 4 cases（4.1%,4 / 98） patients with gouty arthritis showed ANAs ＋, and found 3 kinds antibodies. There was statistical significance in the ANAs positive rate among three joint disease groups（P= 0.000）. 31 combinations were found in all ANAs＋,including 5 combinations in osteoarthropathy group, 29 combinations in RA group, and 3 combinations in gouty arthritis group, in which AntiR o52 / AntiR o60 / AntiS SB, AntiR o52, AntiR o52 / AntiR o60, AntiR o60 and AntiU 1n RNP appeared in at least two diseases;（4）Different positive combinations of ANAs for the same fluorescent type of ANA could be observed in different diseases. Conclusion There was correlation between ANA and ANAs results, but we can not infer the expression of the specific antibodies of ANAs relying on the fluorescent types of ANA. Different fluorescent types of ANA and different positive combinations of ANAs can provide important references for relevant disease diagnosis and treatment, and the diversified expressions of ANA and ANAs in RA and their complexity should provide more referential value for the diagnosis and treatment.