抗U_1RNP抗体在系统性硬化症中的临床意义

Clinical significance of anti-U_1RNP antibodies in systemic sclerosis

目的分析抗U_1RNP抗体与中国系统性硬化症（systemic sclerosis,SSc）患者临床特征及实验室指标的相关性。方法选取上海中西医结合医院、河北以岭医院、成都中医药大学附属医院和中南大学湘雅二医院等4家医院诊断明确的中国SSc患者354例,记录其临床表现和实验室检查结果,同时检测抗U_1RNP、ATA、ACA、SSA、SSB、Sm抗体。统计分析抗U_1RNP抗体阳性患者与阴性患者之间各种临床特征及实验室指标。结果 354例SSc患者中抗U_1RNP抗体的阳性率为25.5%,抗U_1RNP抗体阳性组患者发病年龄为（35.38±12.45）岁,明显低于抗U_1RNP抗体阴性组患者的（39.80±12.81）岁（P〈0.01）。在多因素分析中,抗U_1RNP抗体阳性者较阴性者关节肌肉累及发生率增加,手指点状凹陷症状发生率降低,C3水平降低,白细胞和血小板计数减少,但IgG水平和C3降低发生率明显增高（P〈0.05）。分层分析中,与抗U_1RNP抗体阴性患者相比,阳性组中女性患者不易发生活动后气促症状,而在40-50岁发病的抗U_1RNP抗体阳性患者不易患有消化道累及的症状,病程在12年以上的SSc患者具有较低的皮肤硬度积分（P〈0.05）。抗U_1RNP抗体阳性的SSc患者具有更高的抗Sm、SSA、SSB抗体检出率,而阴性SSc患者有更高的ATA抗体检出率（P〈0.05）。与ATA抗体阳性者比较发现,抗U_1RNP抗体阳性患者仍具有很低的手指点状凹陷症状的发生率（P〈0.05）。结论抗U_1RNP抗体是中国SSc患者的常见自身抗体,与ATA、Sm、SSA、SSB抗体联合检测有助于提高SSc的诊断,U_1RNP抗体阳性的SSc患者应密切关注关节肌肉累及和血液系统的变化,男性患者应注意高密度胆固醇水平的变化。抗U_1RNP抗体阳性患者的SSc严重程度不如ATA阳性的患者,此类患者不易患有手指点状凹陷症状,女性患者不易发生活动后气促,40-50岁发病患者不易累及消化道。

Objective To explore the clinical characteristics and laboratory indicators of Chinese systemic sclerosis（SSc）patients with anti-U1 RNP antibody comparing to U_1RNP-negative patients.Methods SSc patients were enrolled from4 hospitals including Shanghai TCM-Integrated Hospital,Heibei Yiling Hospital,Teaching Hospital of Chengdu University of TCM and the Second Xiangya Hospital of Central South University.Clinical characteristics and laboratory indicators were recorded,and SSc-related antibodies（U_1RNP,ATA,ACA,SSA,SSB and Sm）were determined in all patients.Clinical characterictics and laboratory indicators were analyzed between U_1RNP-positive and negative SSc patients. Results This study included 354 patients,of whom72 cases（25.5%）were U1 RNPpositive.The onset age was lower in U_1RNP-positive patients[（35.38±12.45）years]than that in U_1RNP-negtive patients [（39.80±12.81）years]（P 0.01）.The proportion of joint muscle involvement was higher,but that of fingertip pitting scar was lower in the U_1RNP-positive group.Less C3 level,WBC count and PLT count,but more IgG level and higher ratio of lower baseline C3 level were observed in the U_1RNP-positive group（P0.05）.In U_1RNP-positive group,female SSc patients experienced less shortness of breath after activities.The onset age of 40-50 years had lower proportion of the digestive system involvement.The modified Rodnan Skin Score（mRSS）was lower in SSc patients with more than 12 disease duration（P0.05）.Detection rates of Sm、SSA、SSB were higher,but ATA was lower in U_1RNP-positive SSc patients（P0.05）.Compared to ATA-positive patients,U_1RNP-positive patients had lower proportion of fingertip pitting scar（P 0.05）.Conclusions anti-U1 RNP antibody is a common antibody in Chinese SSc patients,and the detection combined with ATA,Sm,SSA and SSB antibodies will be helpful for diagnosing of SSc the U1 RNPpositive patients should pay attention to the joint muscle involvement and the change of hematological.Male patients of U_1RNP-positive should take note of the change of LDL-C level.Generally speaking,the disease progress of U_1RNP-positive patients was better than that of ATA-positive SSc patients,such as lower proportion of fingertip pitting scar.Compared with ATA-positive patients,female U_1RNP-positive patients were less likely to develop breth shortness after activites and the onset age of40-50 patients experienced less digesttive system involvement.