抗核膜抗体阳性患者在送检抗核抗体中的临床意义

The clinical significance of patients with positive anti-nuclear envelope antibody in the test of antinuclear antibody

目的探讨抗核膜抗体(ANEA)在临床连续送检抗核抗体(ANA)标本中的阳性率及其临床意义。方法回顾性分析该院门诊和住院患者连续送检的107 937例ANA检测标本,对荧光模型判读为ANEA阳性的患者进行临床资料收集与分析。另选取50例ANEA阴性但ANA阳性的患者和65例健康体检者作为疾病对照组和健康对照组,分析ANEA阳性患者实验室检查结果的特点。结果 107 937例ANA常规检测标本中ANA阳性27 467例,ANA总体阳性率为25.45%;荧光模型判读为ANEA 220例,占ANA阳性标本的0.80%。ANEA阳性患者诊断为自身免疫性疾病(AID)141例,其中以原发性胆汁性胆管炎(PBC)最为常见,为30例(21.28%);诊断为非AID患者79例,占ANEA阳性患者的35.91%。AID患者荧光滴度以中、高滴度(1∶320、1∶1 000)为主(66.67%),非AID患者荧光滴度以低滴度(1∶100)为主(81.01%)。与疾病对照组和健康对照组比较,ANEA阳性患者血清γ-谷氨酰转移酶和碱性磷酸酶水平均明显升高,差异均有统计学意义(P<0.05)。结论 ANEA可见于多种临床疾病,主要以AID为主,特别是PBC最为常见。中、高滴度的ANEA阳性患者同时出现GGT、ALP水平异常升高,要注意临床随诊,警惕AID发生。

Objective To explore the positive rate and clinical significance of anti-nuclear envelope antibody(ANEA)in clinical consecutive anti-nuclear antibody(ANA)samples.Methods A retrospective analysis of 107937 cases of ANA test specimens from the outpatient department and inpatients were conducted,and clinical data were collected and analyzed from patients who were judged as ANEA positive by fluorescence model.Another 50 cases of ANA negative but ANA positive and 65 healthy people were selected as the disease control group and the control group,and the characteristics of clinical laboratory examination results of ANEA positive patients were analyzed.Results Among the 107937 ANA routine test samples,27467 were positive,and the positive rate of ANA was 25.45%.220 were ANEA judged by fluorescence model,accounting for 0.80%of ANA positive samples.141 ANEA-positive patients were diagnosed with autoimmune disease(AID),among which primary biliary cholangitis(PBC)was the most common,(30 cases,accounting for 21.28%).79 patients were diagnosed with non-AID,accounting for 35.91%of ANEA positive samples.The fluorescence titers of patients diagnosed with AID were mainly medium and high titer(1∶320,1∶1000),accounting for 66.67%,and the fluorescence titers of non-AID patients were mainly low titer(1∶100),accounting for 81.01%.Compared with the control group,the serumγ-glutamyltransferase and alkaline phosphatase levels of patients with positive ANEA were significantly increased,and the differences were statistically significant(P<0.05).Conclusion ANEA can be found in many diseases,mainly AID,especially PBC is the most common.ANEA positive patients with medium to high titer may accompany with elevated GGT and ALP levels,and should have clinical follow-up and be alert to the occurrence of AID.