摘要
目的 探讨抗SSA抗体在原发性干燥综合征（ss）的诊断价值.方法 选北京协和医院风湿免疫科临床初诊为原发性SS的患者181例,所有病例均按照SS国际合作联盟（SICCA）制定的规范化标准进行唇腺活检（面积≥4 mm^2）,淋巴细胞灶计分（FS）由美国加州大学旧金山医学院口腔科核定;抗SSA抗体在北京协和医院用免疫双扩散法（DID）、Western blot、在SICCA中心实验室用ELISA进行检测.采用卡方及配对卡方检验来分析唇腺病理与抗SSA抗体结果的一致性.结果 （1）DID检测抗SSA抗体阳性者FS〉1比例为83.9%,阴性者FS〉1比例为42.0%,差异有统计学意义（P〈0.0001）;一致性检验Kappa=0.432,假阳性率为16.1%,假阴性率为42.0%.（2）Westernblot检测抗SSA抗体阳性者FS〉1比例为83.0%,阴性者FS〉1比例为51.7%,差异有统计学意义（P〈0.0001）;一致性检验Kappa=0.316,假阳性率为17.0%,假阴性率为51.7%.（3）ELISA检测抗SSA抗体阳性者FS〉l比例为81.5%,阴性者FS〉1比例为38.6%,差异有统计学意义（P〈0.0001）;一致性检验Kappa=0.427,假阳性率为18.5%,假阴性率为38.6%.结论 抗SSA抗体的结果与唇腺FS显著相关,DID和ELISA检测结果与唇腺FS一致性较好,其阳性结果在一定程度上可提示唇腺病理的阳性,避免进一步的有创检查,但阴性结果需进一步采用唇腺活检的规范操作以明确原发性SS诊断.
Objective According to international classification criteria （2002） on Sjogren＇s syndrome, labial pathology was still considered as a major criterion for diagnosis. Standard labial biopsy was hard to be carried out in China. This study is to evaluate whether the invasive labial biopsy could be replaced by noninvasive detection of serum anti-SSA antibody. Methods 181 Chinese patients with the initial diagnosis of primary Sjogren＇s syndrome in Peking Union Medical College Hospital （PUMCH） were enrolled in Sjogren＇s International Collaborative Clinical Alliance （SICCA）. All patients received standard labial biopsies （area of salivary gland tissues≥4 mm^2 ） and focal score （FS） of focal lymphatic sialadenitis were confirmed by pathologists from school of stomatology,University California of San Francisco （UCSF）. Anti-SSA antibodies in sera of all patients were detected by double immunodiffusion （DID） , Western blot in PUMCH and by enzyme-linked immunosorbent assay （ELISA） in central laboratory of SICCA. The correlation between labial pathological findings and serum anti-SSA antibody was studied by χ^2 test and the concordance was calculated by unweighted Kappa. Results （1） Bivariate analysis revealed strong associations of FS 〉 1 with the presence of anti-SSA antibody by DID （ 83.9% vs 42. 0% , P 〈 0. 0001 ）. The accordance between FS and antibody detection by DID was fine with a kappa value of 0. 432. However, there were 16. 1% false-positive antibody reports and 42. 0% false-negative antibody reports. （2）FS 〉 1 was strongly associated with the presence of anti-SSA antibody by Western blot （83.0% vs 51.7%, P 〈 0. 0001 ）. But the accordance between FS and antibody detection by Western blot was only fair with a kappa value of 0. 316. There were 17.0% false-positive antibody reports and 51.7% false-negative antibody reports. （3） FS 〉 1 was strongly associated with the presence of anti-SSA antibody by ELISA （81.5% vs 38.6%, P 〈0. 0001 ）. The accordance between FS and antibody detection by ELISA was fine with a kappa value of 0.427. There were 18.5% false-positive antibody reports and 38.6% false-negative antibody reports. Conclusion In Sjogren＇s syndrome, labial biopsy with FS 〉 1 finding is strongly associated with anti-SSA antibody. Positive results of anti-SSA antibodies by DID or ELISA may indicate FS 〉 1, thus labial biopsy could relatively be avoided, negative results may need further standard labial biopsy procedure to confirm the diagnosis of Sjogren＇s syndrome.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2010年第5期410-413,共4页
Chinese Journal of Internal Medicine
基金
“十一五”国家科技支撑计划（2008BA159B03）
美国国立卫生院项目-干燥综合征国际临床合作联盟（SICCA）
