成人重症肌无力1642例抗核抗体和抗核抗体谱检测结果分析

An Analysis of the Testing Results of Antinuclear Antibody and Antinuclear Antibody Spectrum in 1642 Adults with Myasthenia Gravis

目的研究抗核抗体(antinuclear antibody, ANA)和抗核抗体谱在成人重症肌无力中的分布和临床意义。方法采用间接免疫荧光法(IIF)检测1 642例成人重症肌无力患者抗核抗体,免疫印迹法同时检测ANuA、Anti-P、aha、AMA M2、CENPB、Jo-1、PCNA、PM-Scl、Ro-52、SCL-70、SS-B、Sm、dsDNA、nRNP/Sm、SS-A共15种抗核抗体。结果在1 642例成人重症肌无力患者中,ANA阳性率为39.0%,其中男性阳性者占32.14%,女性阳性者占67.86%,二者差异有统计学意义(P<0.001);同性别不同年龄组间ANA阳性率差异有统计学意义(P<0.05);同年龄组间女性ANA阳性率均高于男性(P<0.001)。成人重症肌无力ANA阳性患者荧光模式分析结果表明,单一荧光核型以均质型最多(34.17%),其次是核斑点型(28.55%)和胞浆型(14.98%)。混合荧光模式以核斑点型/细胞浆型(S/C)为主(4.84%)。ANA阳性患者滴度以1∶100为主,占57.57%。抗核抗体谱以Ro-52、SS-A、AMA M2和CENPB阳性率较高,约70%ANA均质型阳性标本中其ANA谱为阴性。结论成人重症肌无力患者ANA阳性率女性显著高于男性,高年龄组阳性率更高。ANA荧光核型以均质型、核斑点型和胞浆型为主,ANA谱以Ro-52、SS-A、AMA M2和CENPB阳性率较高。约70%ANA均质型阳性标本中其ANA谱为阴性,因此均质型中高度怀疑有其他重症肌无力特异性抗体未被识别。

Objective To study the distributions and clinical significances of antinuclear antibody(ANA) and antinuclear antibody spectrum(ANAs) in adult patients with myasthenia gravis.Methods Indirect immunofluorescence(IIF) was used to detect ANA in 1 642 adult patients with myasthenia gravis. Western blot was used to detect ANAs, including 15 markers such as ANuA, Anti-P, aha, AMA-M2, CENPB, Jo-1, PCNA, PM-Scl, Ro-52, SCL-70, SS-B, Sm, dsDNA, nRNP/Sm, and SS-A.Results Among 1 642 adult patients with myasthenia gravis, the ANA positive rate was 39.0%, of which men accounted for 32.14% and women accounted for 67.86%(P<0.001);the positive rate of ANA among different age groups of the same sex was significantly different(P<0.05);the ANA positive rate was higher in women than men in the same age group(P<0.001). The analysis of the fluorescence pattern of ANA positive patients with myasthenia gravis showed that the most single fluorescent karyotype was homogeneous(34.17%), followed by the nuclear speckle(28.55%) and the cytoplasmic(14.98%). The mixed fluorescence karyotype was mainly nuclear spot/cytoplasmic(S/C)(4.84%). The titer of ANA positive patients was mainly 1∶100, accounting for 57.57%. The ANAs was higher in Ro-52, SSA, AMA M2 and CENPB, and about 70% of ANA homogeneous positive samples had negative ANAs.Conclusion The positive rate of ANA in women with myasthenia gravis is significantly higher than that in men, and the positive rate is higher in the older groups. ANA fluorescent karyotypes are mainly homogeneous, nuclear speckle and cytoplasmic, and the positive rates of ANA spectrum are Ro-52, SSA, AMA M2 and CENPB. Approximately 70% of ANA homogeneous positive specimens have a negative ANAs, suggesting that other myasthenia gravis-specific antibodies are highly suspected in the homogeneous karyotype.