摘要
目的探讨系统性红斑狼疮(SLE)患者治疗后抗核抗体(ANA)及其他自身抗体的转归,以及 ANA的变化与 SLE 病情活动性的关系。方法71例 ANA 阳性的活动期 SLE 患者。经过规律或一度糖皮质激素、环磷酰胺和/或其他免疫抑制剂治疗。复查所有患者的 ANA、部分患者的抗双链 DNA(dsDNA)抗体及可提取核抗原(ENA)抗体谱.ENA 抗体谱包括抗核糖核蛋白(RNP)抗体、抗 Sm 抗体、抗 SSA/Ro 抗体和抗 SSB/La 抗体等。采用SLE 疾病活动指数判断病情活动。结果治疗后共随访6个月～12年,23例 ANA 转阴,转阴率为32.4%,转阴时间4个月～7年,平均(3.4±2.0)年。随访前抗 dsDNA 抗体阳性率为61.9%(26/42),随访后阳性率为22.6%(12/53),26例抗 dsDNA 抗体阳性患者中有18例转阴.抗 dsDNA 抗体阳性的患者均处于活动期。随访前抗 Sm 抗体阳性率为27.8%(15/54),随访后阳性率为17.5%(11/63),15例抗 Sm 抗体阳性的患者有5例转阴。ANA 转阴组有18例患者处于病情缓解期,5例处于活动期,重度活动4例(3例为临终前状态,自身抗体均为阴性)。ANA 转阴组的病情缓解率(78.3%)显著高于 ANA 阳性组(43.8%,X^2=7.480,P=0.006)。ANA 转阴组的神经精神狼疮(NP-SLE)发生率(4.3%)显著低于 ANA 阳性组(25%.P=0.031)。ANA 转阴与 NP-SLE 具有显著相关性(r=-0.250,P=0.036)。结论 ANA 与 SLE 病情活动不一定平行,SLE 冶疗后 ANA 可以转阴,抗 Sm 抗体亦可能转阴。
Objective To evaluate the changes of antinuclear antibody （ANA） and other autoantibodies in patients with systemic lupus erythematosus （SLE）, and the relationship between autoantibodies and disease activity. Methods ANA was tested in 71 active SLE patients at time of diagnosis （TD） and during follow-up. Other autoantibodies were examined in most patients including anti-dsDNA, anti-Sm, anti-RNP, anti-SSA/Ro, and anti-SSB/La antibodies. Disease activity was also assessed by SLE disease activity index. Result Patients were followed up from 6 months to 12 years. For ANA, during follow-up, 23 of 71 patients （32.4%） changed to negative. Among 71 cases, the long-term analysis revealed a decrease in the prevalence of ANAs （TD： 100%; follow-up： 52.6%）, anti-dsDNA antibody （TD： 61.9%; follow-up： 22.6%）, and anti-Sm antibody （TD： 27.8%; follow-up： 17.5%） over time. Among these 23 ANA negative cases, 18 were in disease remission, 5 cases were still in active stage. Particularly, autoantibodies in 3 severe SLE patients turned to be negative before their death. The ratio of disease remission of ANA negative patients （78.3%） was significantly higher than ANA positive patients （43.8%, X2=7.480, P = 0.006）. Positive correlation was found between change of ANA to negative and neuropsychiatric SLE （r=-0.250, P=0.036）. Conclusions Our results have demonstrated that positivity of ANA is not completely associated with disease activity in SLE. With treatment, ANA may turn to be negative. Anti-Sm antibody may also turn to be negative.
出处
《中华临床免疫和变态反应杂志》
2007年第1期48-52,共5页
Chinese Journal of Allergy & Clinical Immunology
关键词
红斑狼疮
系统性
抗核抗体
随访
lupus erythematosus, systemic
antinuclear antibodies
follow-up
