临床抗Ro52SSA抗体对发展为干燥

作者：ElkeTheander译者：于若寒

摘要目的：自身抗体是原发性干燥综合征（pSS）主要特征，并且对于研究其机制提供了重要的工具。然而，至今没有评价诊断前自身抗体存在情况的系统研究。本研究目的是分析自身抗体在确诊前多早、出现的顺序以及他们对于pSS的预测性，及它们是否能够确定疾病的亚型。方法：采用巢式病例对照设计，数据来源于马尔默pSS注册资料，并且应用了3个瑞典医疗保健生物标本库。总共收集了例诊断pSS之前的患者的血清标本个和例匹配对照者的血清标本个，检测其ANAs、RF、抗Ro60/SSA抗体、抗Ro52/SSA抗体和抗La/SSB抗体。

结果考虑到所有的患者在诊断pSS后自身抗体都是阳性的，81%的患者在诊断前多达20年（平均4.3-5.1年）可检测到至少一种特异的自身抗体。最常见的抗体是ANAs抗体，之后依次是RF、抗Ro60/SSA、抗Ro52/SSA和抗La/SSB抗体。抗Ro/SSA和抗La/SSB抗体与发展为pSS的风险显著相关，特别是早期发病和较严重的病程。当在pSS患病率估计之前在计算中包含贝叶斯定理，抗Ro60/SSA和抗Ro52/SSA抗体有最高的阳性预测值（分别是25%和%）。

结论：我们的结果提示,自身抗体在诊断pSS之前18-20年就存在，但是因为对于多数病人，最早的血清样本是阳性的，因此，我们不排除在更早的时间就出现血清学阳性。在有多个自身免疫性疾病的家族中，自身抗体联合基因风险的评价，可以在疾病前状态确定易感的患者。

附原文：ObjectiveAutoantibodiesarehighlycharacteristicofprimarySj?grenssyndrome(SS)andrepresentimportanttoolsforstudyingitspathogenesis.Nonetheless,thusfar,nosystematicinvestigationshaveassessedthepresenceofautoantibodiesbeforediagnosis.Thisstudywasundertakentoanalyzehowearlyandinwhatorderautoantibodiesappear,howpredictivetheyareofprimarySS,andwhethertheyidentifydiseasesubsets.MethodsAnestedcase–controldesignlinkingdatafromtheMalm?primarySSregistryand3Swedishhealthcarebiobankswasapplied.Inall,serumsamplesobtainedfromindividualsbeforediagnosisofprimarySSand1serumsamplefromeachofmatchedcontrolswereanalyzedforantinuclearantibodies(ANAs),rheumatoidfactor(RF),andantibodiesagainstRo60/SSA,Ro52/SSA,andLa/SSB.ResultsConsideringallpatientswithprimarySSwhowereautoantibodypositiveafterdiagnosis,atleastoneautoantibodyspecificitywasdetectedin81%upto20years(median4.3–5.1years)beforediagnosis.ThosefoundmostoftenwereANAs,followedbyRF,anti–Ro60/SSA,anti–Ro52/SSA,andanti-La/SSB.Anti-Ro/SSAandanti-La/SSBantibodieswerestronglyassociatedwiththeriskofdevelopingprimarySS,especiallyearly-onsetdiseaseandaseverediseasecourse.WhenBayesianpriorprevalenceestimatesforprimarySSwereincludedinthecalculation,prediagnosticanti–Ro60/SSAandanti–Ro52/SSAhadthehighestpositivepredictivevalues(25%and%,respectively).ConclusionOurfindingsindicatethatautoantibodiesarepresentforupto18–20yearsbeforethediagnosisofprimarySS,butwecannotexcludeevenearlierseropositivity,sinceformostpatients,theearliestsampleanalyzedwaspositive.Infamilieswithmultiplecasesofautoimmunedisease,autoantibodyprofiling,alongwithassessmentofgeneticrisk,enablesidentificationofsusceptibleindividualsinaprediseasestate.引自：Theander,E.,Jonsson,R.,Sj?str?m,B.,Brokstad,K.,Olsson,P.andHenriksson,G.(),PredictionofSj?grensSyndromeYearsBeforeDiagnosisandIdentificationofPatientsWithEarlyOnsetandSevereDiseaseCoursebyAutoantibodyProfiling.ArthritisRheumatology,67:–.doi:10.2/art.