新疆维吾尔自治区库车县维吾尔族人类免疫缺陷病毒感染者血清自身抗体及人类白细胞抗原-B27检测的临床意义初探

The clinical significance of serum autoantibodies and HLA-B27 molecule testing in Uygur patients with human immunodeficiency virus infection

目的初步探讨新疆维吾尔自治区库车县维吾尔族人类免疫缺陷病毒(HIV)感染者血清自身抗体、人类白细胞表面抗原(HLA)-B27检测的临床意义。方法收集2016年5月至2017年3月在新疆维吾尔自治区库车县传染病医院登记随访的727例维吾尔族HIV感染者的临床资料和实验室检查,同时抽取HIV感染者及390例同民族健康志愿者外周血,检测抗核抗体(ANA)、抗环瓜氨酸多肽(CCP)抗体、抗可提取性核抗原(ENAs)抗体及HLA-B27。结果维吾尔族HIV感染者727例,男性317例,女性410例,年龄(35.52±13.44)岁,病程(6.34±3.05)年,其中697(95.87%)例正在接受高效抗逆转录病毒治疗(HAART),治疗时间(5.52±3.47)年。202例HIV感染者CD4^+T细胞数(520±271)个/μl,20例HIV感染者病毒载量(108139±20498)拷贝/ml。238例(32.74%)HIV感染者出现风湿病症状,其中以口眼干(15.41%)、脱发(9.90%)、关节痛(8.94%)最常见。HIV感染者ANA阳性率为33.43%(243/727),高于健康对照者(17.43%),差异有统计学意义(P<0.001),以1∶100低滴度阳性为主。与健康对照者比,HIV感染者抗U1核糖核蛋白抗体阳性率高(1.10%),而抗SSA抗体(0.14%)、抗CCP抗体(0.28%)阳性率较低。HAART者ANA阳性率(32.71%)较未治疗者(50.00%)低。相关性分析发现,抗逆转录病毒治疗时间、CD4^+T细胞数、病毒载量与ANA无相关性(r值分别为0.061、0.047、0.121,P值均<0.05)。仅1例(0.14%)女性HIV感染者HLA-B27阳性,低于健康对照者(3.08%;P<0.001)。HIV感染者中仅发现1例合并类风湿关节炎。结论维吾尔族HIV感染者可出现多种风湿病表现,且血清中可检测到多种自身抗体,临床上极易与风湿病混淆,因此,对有多种风湿病表现的患者应警惕HIV感染的可能。

Objective To explore the clinical value of serum autoantibodies and human leukocyte antigen(HLA-B27)molecular testing in Uygur patients with human immunodeficiency virus(HIV)infection.Method A total of 727 HIV-infected Uygur patients who visited Kuche infectious diseases hospital during May 2016 to March 2017 were include in this study.The other 390 healthy people were enrolled as controls.Serum antinuclear antibodies(ANA),anti-cyclic citrullinated peptide(CCP)antibody,anti-extractable nuclear antigen(ENAs)antibody and HLA-B27 molecule were tested.Result Among 727 HIV-infected Uygur patients,317 were males and 410 were females with mean age(35.52±13.44)years old.The mean duration of disease was(6.34±3.05)years.There were 697(95.87%)patients receiving highly active antiretroviral therapy(HAART)with mean duration of treatment(5.52±3.47)years.The mean CD4^+T cell count was(520±271)cells/μl in 202 HIV-infected patients,and mean virus load was(108139±20498)copies/ml in 20 HIV-infected patients.Rheumatic manifestations were recorded in 238(32.74%)HIV-infected Uygur patients,mainly with dry mouth and dry eye(15.41%),alopecia(9.90%),arthralgia(8.94%),ect.Compared with the health controls,positive ANA was more common in HIV infected Uygur patients(33.43%vs.17.43%,P<0.001)with low titers(ANA titer:1∶100).HIV-infected Uygur patients had higher positive anti-u1-RNP antibodies positive rate(1.10%),but lower anti-SSA antibodies positive rate(0.14%)and anti-CCP antibodies positive rate(0.28%).Patients with positive ANA in HAART group were significantly less than that in non-treatment group(32.71%vs.50.00%,P=0.049).There were no correlations between ANA and duration of HAART,CD4^+T cell counts and virus load(r values 0.061,0.047,0.121,respectively.P>0.05).Only one female patient was HLA-B27 positive(0.14%),which was significantly lower than that in healthy controls(3.08%)(P<0.001).Also,only one patient was diagnosed with rheumatoid arthritis(RA).Conclusion Autoimmune manifestations are common in HIV-infected Uygur patients.Several autoantibodies are positive,but the coincidence of rheumatic diseases is rare.It's noted that patients with autoimmune manifestations should be considered as a differential diagnosis of HIV infection.