系统性硬化症患者抗RNA多聚酶Ⅲ抗体的检测及其临床意义

目的检测中国系统性硬化症（SSc）患者中抗RNA多聚酶Ⅲ抗体（ARA）的表达水平,探讨其在SSc临床诊治中的意义。方法前瞻性连续纳入135例SSc患者,利用免疫印记法检测ARA,分析其在SSc患者中的阳性率及其与各种临床特征的相关性。结果 ARA检出率为8.9%（12例）,其中7例存在于抗拓扑异构酶Ⅰ抗体（亦称抗Scl-70抗体）和抗着丝点抗体（ACA）阴性的患者中。ARA阳性组的血清肌酐和尿素氮水平显著高于阴性组（P〈0.001）,但2组在改良Rodnan皮肤硬化评分、皮肤病变指标、疾病进程、心血管、肺脏、消化系统及肾脏受累的差异无统计学意义（P均〉0.05）。结论 ARA对于抗Scl-70抗体及ACA阴性的SSc具有一定的诊断价值。在中国SSc患者中,ARA阳性者肾功能指标较阴性组差,但皮肤、心、肺受累等临床特征在两组间差异无统计学意义,ARA抗体阳性组疾病进程无显著加快,提示中国SSc患者与其他地区患者间可能存在着种族差异。

Detection of Anti-RNA Polymerase Ⅲ Antibody and Its Association with Clinical Features in Systemic Sclerosis

Objective To detect anti-RNA polymerase Ⅲ（ARA） in sera of systemic sclerosis（SSc） patients and to assess its clinical relevance.Methods Immunoblotting assay was used to detect the presence of ARA in sera of 135 Chinese patients with SSc,who were prospectively and consecutively enrolled in the study.Association of prevalence of ARA in SSc patients and their clinical characteristics was analyzed.Results ARA was detected in 8.9%（n=12） of SSc patients,among whom seven could not detect anti-Scl-70 and anti-centromere antibody（ACA）.Our series revealed that serum creatinine and blood urea nitrogen level were significantly higher in ARA positive group（P0.001）.However,the association between ARA and clinical features or laboratory findings including modified Rodnan skin score,cardiac,pulmonary,gastrointestinal or renal involvements were not identified（all P0.05）.Conclusion ARA may be helpful in diagnosing SSc,especially for those anti-Scl-70 or ACA can not be detected.ARA positive patients have significantly increased creatinine and blood urea nitrogen level.There is no clinical relevance to other clinical or laboratory features between patients with or without ARA.Chinese SSc patients＇ serological features may be different from other races.