1例ANA免疫荧光阴性而确诊干燥综合征的病例分析

Antinuclear Antibody-Negative Sjogren’s Syndrome Using Indirect Immunofluorescence:a Case Analysis

目的通过1例ANA免疫荧光阴性而确诊干燥综合征的病例研究,分析抗核抗体不同方法学试剂检测结果存在差异的原因,探讨自身抗体不同方法学试剂搭配使用策略以及广谱筛查在自身免疫病早期诊断中的重要性。方法对1例确诊的干燥综合征病例进行不同方法学抗核抗体检测以及不同类型自身抗体谱筛查。结果患者女,45岁,眼干、口干、多年前确诊为干燥综合征。ANA免疫荧光结果为阴性,化学发光结果为阳性,进一步筛查发现抗SS-A/Ro抗体阳性、抗环瓜氨酸肽抗体阳性、类风湿因子阳性。同时患者存在晨僵与关节肿胀,完全符合类风湿关节炎早期诊断标准,确诊为干燥综合征合并类风湿关节炎。结论自身抗体检测应注重多种方法学的合理搭配,同时对于临床高度疑似自身免疫病的患者,高危人群建议进行自身抗体广谱筛查,有助于潜在自身免疫病的早期诊断和早期治疗。

Objective By analyzing a case of ANA immunofluorescence-negative Sjogren’s Syndrome, to explore reasons leading to different results of different methodological reagents for ANA, and to explore the use of different methodological reagents for autoantibodies and the importance of broad-spectrum screening in the early diagnosis of autoimmune diseases.Methods A confirmed case of Sjogren’s Syndrome was tested with different methodologies for antinuclear antibody and different types of autoantibody profile screening.Results A 45-year-old female presented with oral and ocular symptoms, diagnosed with Sjogren’s Syndrome many years ago was studied. Her ANA was negative by IIF, while positive by CLIA. Further screening revealed positive anti-SS-A/Ro antibodies, positive anti-cyclic citrullinated peptide antibodies, and positive rheumatoid factor. This patient had morning stiffness and joint swelling, which basically met the criteria for the early diagnosis of Rheumatoid Arthritis, diagnosed with Sjogren’s Syndrome overlapping Rheumatoid Arthritis.Conclusion Autoantibody detection should be conducted with a reasonable combination of methodologies. For patients highly suspected of autoimmune diseases, it is recommended to carry out a broad-spectrum autoantibody screening, which is helpful for the early diagnosis and early treatment of potential autoimmune diseases.