摘要
目的:研究抗着丝点抗体(ACA)与临床疾病及其它实验资料的关系。方法:回顾性总结近五年32043例抗核抗体(ANA)阳性结果中506例ACA阳性患者的临床信息和实验资料。结果:ACA阳性仅占ANA阳性的1.58%(506/32043)。据临床诊断将506例ACA阳性患者分为确诊组261例和非确诊组245例。在确诊组中自身免疫疾病患者204例(78.16%),非自身免疫疾病患者57例(21.84%)。在自身免疫疾病患者中,系统性红斑狼疮46例(22.55%),雷诺氏症32例(15.69%),类风湿性关节炎30例(14.71%),进行性系统性硬化症27例(13.24%),结缔组织病19例(9.31%),干燥综合征19例(9.31%),局限型硬皮病14例(6.86%),多肌炎/皮肌炎6例(2.94%),其它疾病如混合性结缔组织病、骨关节炎、重叠综合症、自身免疫性肝病共计11例(5.39%);在57例非自身免疫疾病中,以肾脏疾病、癌症患者、肝脏疾病及肺部疾病为主,其分别为17例、9例、8例和8例。在245例非确诊组中,142例患者临床医生未提供临床信息,22例无症状病例在查体时检出ACA阳性,其占ACA阳性总数的4.35%。另81例具有明显临床症状,其中关节痛/肌痛19例(23.46%),面部红斑9例(11.11%),口眼干燥8例(9.88%),皮肤硬化8例(9.88%),发热5例(6.17%),血小板减少4例(4.94%),其它症状如蛋白尿、手指发绀、胸水、肝功异常等共计28例(34.57%)。结论:单纯ACA阳性是ANA检测中较少见的一种荧光模型,其主要与自身免疫疾病相关,特别是系统性红斑狼疮、雷诺氏症、类风湿性关节炎、进行性系统性硬化症、结缔组织病、干燥综合征、局限型硬皮病及多肌炎/皮肌炎有明显相关关系;在非自身免疫疾病患者中ACA与肾脏疾病、癌症、肝脏及肺部疾病相关;ACA阳性患者临床症状从无到严重脏肾损伤,因此对其应严密监测,早期治疗,防止肝、肾进一步的损害;对于无症状的ACA阳性患者需进行前瞻性观察,以确定其转归。
Objective： To study the relationship between anticentromere antibodies （ACA） and the different diseases or symptoms. Methods： 506 patients with positive ACA （only ACA） from 32043 positive antinuclear antibody （ANA） were retrospective analyzed for the latest 5 years. Results： 506 cases were positive with ACA （only ACA） in 32043 ANA positive cases. All cases were divided into two groups by the clinical diagnosis. 261 cases were final confirmed clinical diagnosis. 245 cases were not confinned. In final diagnosis group 204 cases were autoimmune disease （AID） （78.16%） and 57 patients were not autoimmune disease （NMD） （21.84%）. In AID group 46 cases were systemic lupus erythematosus （SLE） （22.55%）, 32 were Raynand＇s phenomenon （ 15.69% ）, 30 were rheumatoid arthritis （RA） （ 14.71% ）, 27 progressive systemic sclerosis （PSS） （ 13.24% ）, 19 were connective tissue disease （CTD） （9.31%）, 19 Sjogren＇s syndrome （SS） （9.31%）, 14 with localized sclerodenna （6.86%）, 6 polymyositis （PM） /dermatomyositis （DM） （2.94%）. In 57 NMD group, kidney disease 17, cancer 9 liver disease, 8 and lung disease 8. No information was afforded by clinical doctor in 142 cases from undetermined diagnosis group, positive ACA result were found by routine examine in 22 cases without symptoms. Total of 81 cases there were many kinds of chnical symptoms. For example 19 with joint and/or muscle pain （23.46 % ）, 9 with erythema （ 11.11% ）, 8 with the dry mouth or xerophthalmia and sclerosis of the skin respectively （ 9.88% ）, 5 with fever （6.17%）, 4 with thrombocytopenia （4.94%）, 28 with other symptoms such as proteinuria, finger cyanopathy, pleural effusion, liver function disorder and so on （34.57 % ）. Conclusion： Only ACA positive is a seldom pattern in the ANA test, the major clinical characteristics of the patients correlated with ACA are autoimmune disease, especially such as SLE, Raynaud＇s phenomenon, RA, PSS, CTD etc. Patient with kidney disease or malignant disease or liver disease or lung disease are frequent in NAID group for ACA positive. More attention should be paid to follow up the symptom observation. So the patients with positive ACA early treatment should be given to prevent the pathological lesion developed. More study should be done in the patients with positive ACA but without any symptoms.
出处
《华西医学》
CAS
2005年第4期650-652,共3页
West China Medical Journal
关键词
抗着丝点抗体
系统性红斑狼疮
雷诺氏症
类风湿性性关节炎
系统性硬化症
恶性病变
Anticentromere antibody
Systemic lupus erythematosus
Raynaud＇s phenomenon
Rheumatoid arthritis
Progressive systemic sclerosis
Malignant disease
