流式细胞术检测HLA-B27临界值的设置对强直性脊柱炎诊断的影响

目的通过流式细胞术检测外周血白细胞HLA-B27的表达强度并根据临床诊断,探讨HLA-B27临界值的设置对强直性脊柱炎（Ankylosing spondylitis,AS）诊断的影响。方法利用美国BD公司流式细胞仪检测148例AS患者、296例非AS（包括骶髂关节炎68例,反应性关节炎124例,其他关节病104例）患者及40例健康体检者的外周血HLA-B27表达强度。结果以美国Becton Dickinson公司设定的界值≥荧光强度146道数为准,AS组中,HLA-B27阳性仅87例（58.78%）,其中有24例检测值在140-145道数之间;非AS组中,HLA-B27阳性13例（4.40%）;健康对照组中,HLA-B27阳性2例（5.00%）。结论AS组阳性率过低,与临床不符。进口试剂盒设置的临界值过高,会漏诊相当一部分AS患者。如降低其临界值,可提高流式细胞术检测HLA-B27抗原的阳性率,在AS的临床诊断及鉴别诊断中发挥重要的作用。

The settting of flow cytometer assay critical value for HLA-B27 in patients with ankylosing spondylitis

Objective To investigate the express levels of HLA-B27 in patients with ankylosing spondylitis（AS） by flow cytometer assay,and according to the clinical diagnosis,to discuss the clinical signification of the setting of chnical value to the diagnosis of AS. Methods We used flow eytometer from American BD company to test the express levels of HLA-B27 from 148 patients with AS, 296 non-As patients （including 68 patients with sacroiliitis, 124 patients with reactive arthritis and 104 patients with other arthronosos） and 40 healthy controls. Results According to the critical value of BD（ ≥ 146） ,there were only 87 positive cases （58.78%） in AS group,and there were 24 AS patients whose HLA-B27 levels were between 140 and 145, there were 13 positive cases （4.40%） in non-AS group,and there were 2 positive cases （5.00%） in healthy group. Conclusion The positive rate in AS group was too low, which didn＇ t correspond with the clinical diagnosis. The critical value of imparting reagent box was so high that a large amount of patients were let off. If we lower the critical value,the positive rate of HLA-B27 with flow cytometer could be raised,and flow cytometer could be more useful to the clinical diagnosis and differential diagnosis.