Imazio Massimo, Brucato Antonio, Doria Andrea, Brambilla Giovanni, Ghirardello Anna, Romito Alessandra, Natale Giuseppe, Palmieri Giancarlo, Trinchero Rita, Adler Yehuda
Cardiology Department, Ospedale Maria Vittoria, Torino, Italy.
Int J Cardiol. 2009 Aug 21;136(3):289-93. doi: 10.1016/j.ijcard.2008.05.020. Epub 2008 Jul 31.
A positive result for antinuclear antibodies (ANA), often as a fortuitous observation, may be cause for concern in idiopathic recurrent pericarditis (IRP), nevertheless data are lacking on their prevalence and clinical significance. This study is sought to investigate the prevalence and clinical significance of ANA in IRP.
ANA titres were assessed in consecutive patients with recurrent pericarditis, and matched healthy controls. Baseline and follow-up data were recorded and compared according to ANA results.
A total of 145 consecutive patients with recurrent pericarditis were studied: 122 patients with IRP, 23 patients with pericarditis due to known etiologies (rheumatologic diagnoses and postpericardiotomy syndrome), and 122 healthy controls. ANA were detected in 53 of 122 (43.4%) patients with IRP, and in only 12 of 122 (9.8%) controls (p<0.001). Low titres (1/40-1/80) were found in the majority of cases, while moderate positivity (1/160-1/320) was more common in patients with a known rheumatic disease (26.7% vs. 5.7%; p=0.020). High concentrations of ANA (> or =1/640) were not recorded. Women were at increased risk for ANA (OR 2.22 95%CI 1.07-4.60; p=0.033). During a mean follow-up of 32 months, complications and new diagnoses were similar in patients with or without ANA positivity.
Low-positive titres are more common in patients with IRP than in controls, suggesting a possible autoimmune pathogenesis. Nevertheless, they are often a clinically non-specific finding. Routine serologic testing for ANA suggests a source for recurrent pericarditis in less than 10% of cases, and in these cases other evidence typically suggests the underlying disease.
抗核抗体（ANA）检测结果呈阳性，常在偶然检查中发现，这在特发性复发性心包炎（IRP）中可能令人担忧，然而目前缺乏关于其患病率及临床意义的数据。本研究旨在调查ANA在IRP中的患病率及临床意义。
对连续性复发性心包炎患者及相匹配的健康对照者进行ANA滴度评估。根据ANA检测结果记录并比较基线及随访数据。
共对145例连续性复发性心包炎患者进行研究，其中122例为IRP患者，23例为已知病因（风湿性诊断及心包切开术后综合征）的心包炎患者，以及122名健康对照者。122例IRP患者中有53例（43.4%）检测到ANA，而122名对照者中仅有12例（9.8%）检测到ANA（p<0.001）。大多数病例ANA滴度较低（1/40 - 1/80），而中度阳性（1/160 - 1/320）在已知风湿性疾病患者中更为常见（26.7%对5.7%；p = 0.020）。未记录到高浓度ANA（≥1/640）。女性ANA阳性风险增加（比值比2.22，95%可信区间1.07 - 4.60；p = 0.033）。在平均32个月的随访期间，ANA阳性和阴性患者的并发症及新诊断情况相似。
低阳性滴度在IRP患者中比对照者更常见，提示可能存在自身免疫发病机制。然而，它们通常是临床上非特异性的表现。ANA的常规血清学检测提示不到10%的复发性心包炎病例存在病因，在这些病例中，其他证据通常提示潜在疾病。
