摘要
目的探讨组织特异性自身抗体(TSA)(抗TSA三项)在原发性干燥综合征(pSS)诊断中的应用价值。方法回顾性收集2024年1至12月新疆维吾尔自治区人民医院130例pSS患者、97例系统性红斑狼疮(SLE)患者及150名健康体检者(HC组)的一般资料。采用酶联免疫吸附试验检测血清抗TSA三项[抗碳酸酐酶6(CA6)抗体、抗腮腺蛋白(PSP)抗体、抗唾液腺蛋白1(SP1)抗体]水平,采用免疫印迹法检测所有对象传统血清学指标[抗SS抗原A(SSA)抗体、抗SS抗原B(SSB)抗体和抗Ro52抗体]水平,采用间接免疫荧光法检测抗核抗体水平。建立健康人群抗TSA三项参考范围(P90.0/P95.0/P97.5)。采用ROC曲线分析抗TSA三项对pSS的诊断效能,比较不同TSA组合的诊断效能,评估其在传统血清学指标阴性pSS患者中的补充诊断价值及与病程的关联。结果3组对象抗TSA三项水平比较差异均有统计学意义(均P<0.05)。pSS组患者血清中抗CA6抗体水平高于SLE组,抗SP1抗体水平低于HC组,抗PSP抗体水平高于HC组和SLE组,差异均有统计学意义(均P<0.05)。ROC曲线显示,抗SP1抗体对pSS的诊断效能最优(AUC=0.641)。组合诊断中,“抗PSP抗体阳性+任一其他TSA抗体阳性”在P95.0参考范围下表现最优,灵敏度0.208、特异度1.000、约登指数0.208。传统血清学指标阴性pSS患者中,抗PSP抗体阳性率最高(34.67%~38.60%)。传统抗体阳性亚组中,抗CA6、抗SP1、抗PSP抗体阳性患者病程均明显短于传统抗体阴性亚组(均P<0.05)。结论抗TSA三项在pSS患者辅助诊断中有较好的诊断效能,并在传统血清学指标抗核抗体、抗SSA抗体阴性的pSS患者中有一定补充诊断的价值,且与pSS患者病程相关。
Objective To investigate the application value of the three tissue-specific autoantibodies(TSA)in the diagnosis of primary Sjogren's syndrome(pSS).Methods General data of 130 pSS patients,97 systemic lupus erythematosus(SLE)patients,and 150 healthy individuals who underwent physical examination(HC group)were collected retrospectively from People's Hospital of Xinjiang Uygur Autonomous Region between January and December 2024.Serum levels of the three TSA[anti-carbonic anhydrase 6(CA6)antibody,anti-parotid secretory protein(PSP)antibody,and anti-salivary gland protein 1(SP1)antibody]were detected by enzyme-linked immunosorbent assay.Traditional serological indicators[anti-Sjogren's syndrome antigen A(SSA)antibody,anti-Sj o gren's syndrome antigen B(SSB)antibody,and anti-Ro52 antibody]were measured by immunoblotting,and anti-nuclear antibody was detected by indirect immunofluorescence.Reference ranges of the three TSA in healthy individuals were established by percentile method(P90.0/P95.0/P97.5).ROC curves were used to analyze the diagnostic efficacy of the three TSA for pSS,and the diagnostic performance of different TSA combinations was compared.Their supplementary diagnostic value in pSS patients with negative traditional serological indicators and correlation with disease duration were further evaluated.Results Statistically significant differences were observed in the levels of the three TSA among the three groups(all P<0.05).Serum levels of anti-CA6 antibody in the pSS group were higher than those in the SLE group,levels of anti-SP1 antibody were lower than those in the HC group,and levels of anti-PSP antibody were higher than those in both the HC group and the SLE group,with statistically significant differences(all P<0.05).ROC curve analysis showed that anti-SP1 antibody had the optimal diagnostic efficacy for pSS(AUC=0.641).Among the combined diagnostic strategies,"anti-PSP antibody positive+any other TSA positive"under the P95.0 reference range exhibited the best performance,with a sensitivity of 0.208,specificity of 1.000,and Youden index of 0.208.Among pSS patients with negative traditional serological indicators,the positive rate of anti-PSP antibody was the highest(34.67%-38.60%).In the traditional antibody-positive subgroup,the disease duration of patients positive for anti-CA6,anti-SP1,or anti-PSP antibodies were significantly shorter than that in the traditional antibody-negative subgroup(all P<0.05).Conclusion The three TSA have good diagnostic performance in the auxiliary diagnosis of pSS,and provide certain supplementary diagnostic value for pSS patients with negative traditional serological indicators such as anti-nuclear antibody and anti-SSA antibody.Additionally,they are correlated with the disease duration of pSS patients.
作者
孟新艳
张莎
雷鑫
武丽君
王雯婧
石亚妹
MENG Xinyan;ZHANG Sha;LEI Xin;WU Lijun;WANG Wenjing;SHI Yamei(Department of Rheumatology and Immunology,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)
出处
《浙江医学》
2025年第24期2630-2635,共6页
Zhejiang Medical Journal
基金
新疆维吾尔自治区重点研发计划项目(2022B03002-1)
新疆维吾尔自治区人民医院院内项目(20220216)。
关键词
干燥综合征
组织特异性自身抗体
抗碳酸酐酶6抗体
抗唾液腺蛋白1抗体
抗腮腺蛋白抗体
Sjogren's syndrome
Tissue-specific autoantibody
Anti-carbonic anhydrase 6 antibody
Anti-salivary gland protein 1 antibody
Anti-parotid secretory protein antibody
