抗核抗体联合抗核抗体谱检测在自身免疫性疾病诊断中的应用

目的探讨抗核抗体(ANA)联合抗核抗体谱(ANAs)检测在自身免疫性疾病(AID)诊断中的应用价值。方法选择漳州市中医院2017年2月-2019年10月收治的98例AID患者作为AID组,按疾病类型分为6个亚组,分别为系统性红斑狼疮(SLE)组32例,类风湿性关节炎(RA)组34例,干燥综合征(SS)组13例,进行性系统性硬化症(PSS)组7例,混合性结缔组织病(MCTD)组6例,过敏性紫癜(AP)组6例;另选同期收治的非AID患者98例为非AID组。分析各组ANA和ANAs阳性表达情况以及AID组中ANA核型与ANAs表达情况。结果 SLE组ANA阳性率最高〔93.75%(30/32)〕,其次为MCTD、SS、PSS、RA组,均明显高于非AID组〔83.33%(5/6)、76.92%(10/13)、71.43%(5/7)、35.29%(12/34)比5.10%(5/98)〕,差异均有统计学意义(均P<0.05);SLE组抗SmDl、抗Ul-Sn RNP、抗dsDNA、抗SSA、抗SSB、抗组蛋白、抗核小体阳性率均明显高于非AID组,RA组抗SSA、抗组蛋白阳性率明显高于非AID组,SS组抗SSA、抗SSB阳性率明显高于非AID组,PSS组抗Scl-70阳性率明显高于非AID组,MCTD组抗Rib-P、抗SmDl、抗Ul-Sn RNP、抗SSA阳性率明显高于非AID组,差异均有统计学意义(均P<0.05)。AID组中ANA总阳性率高于ANAs阳性率〔64.29%(63/98)比58.16%(57/98)〕,但差异无统计学意义(P>0.05);47例ANA、ANAs均为阳性患者经核型分析显示,核均质主要为抗dsDNA、抗核小体、抗组蛋白表达,核颗粒多为抗dsDNA、抗组蛋白、抗SSB表达,其余核型较为少见。结论 ANA可辅助诊断AID,但特异性欠佳,联合ANAs诊断可提高临床诊断准确率,指导治疗。

Application of antinuclear antibody combined with antinuclear antibody spectrum in diagnosis of autoimmune disease

Objective To explore the application value of antinuclear antibody(ANA)combined with antinuclear antibody spectrum(ANAs)in diagnosis of autoimmune disease(AID).Methods The 98 AID patients admitted to Zhangzhou Hospital of Traditional Chinese Medicine from February 2017 to October 2019 were selected as AID group.According to the type of disease,the patients were divided into six subgroups such as systemic lupus erythematosus(SLE)group(32 cases),rheumatoid arthritis(RA)group(34 cases),Sjogren syndrome(SS)group(13 cases),progressive systemic sclerosis(PSS)group(7 cases),mixed connective tissue disease(MCTD)group(6 cases)and allergic purpura(AP)group(6 cases).Other 98 patients without AID were selected as non-AID group.The positive expression of ANA and ANAs in each group and ANA karyotype and expression in AID group was analyzed.Results The positive rate of ANA in SLE group was the highest93.75%(30/32)],followed by MCTD,SS,PSS and RA groups,which were significantly higher than that in non-AID group83.33%(5/6),76.92%(10/13),71.43%(5/7),35.29%(12/34)vs.5.10%(5/98)],with significant differences(all P<0.05).The positive rates of anti SmDl,anti Ul-Sn RNP,anti dsDNA,anti SSA,anti SSB,anti histone and anti nucleosome in SLE group were significantly higher than those in non-AID group;the positive rates of anti SSA and anti histone in RA group were significantly higher than those in non-AID group;the positive rates of anti SSA and anti SSB in SS group were significantly higher than those in non-AID group;the positive rate of anti Scl-70 in PSS group was significantly higher than that in non-AID group.The positive rates of anti Rib-P,anti SmDl,anti Ul-Sn RNP and anti SSA in MCTD group were significantly higher than those in non-AID group,with significant differences(all P<0.05).In AID group,the total positive rate of ANA was higher than that of ANAs64.29%(63/98)vs.58.16%(57/98)],without significant difference(P>0.05).In 47 cases with positive ANA and ANAs,the karyotype analysis showed that the nuclear homogeneity was mainly anti dsDNA,anti nucleosome and anti histone,most of the nuclear particles were anti dsDNA,anti histone and anti SSB,and the other karyotypes were rare.Conclusions ANA can assist in the diagnosis of AID,but the specificity is not good.ANA combined with ANAs diagnosis can improve the accuracy of clinical diagnosis and guide the treatment.