Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Rheumatology (Oxford). 2013 Feb;52(2):337-45. doi: 10.1093/rheumatology/kes261. Epub 2012 Oct 4.
This study aims to identify the existence of, and relationship between autoantibody clusters and clinical subsets in Chinese SLE patients.
Data from 1928 SLE patients from Hong Kong were analysed. Using cluster analysis, patients were grouped by autoantibodies into clusters. The frequencies of various clinical manifestations were then compared between each cluster. Separate association analyses between individual autoantibodies and clinical manifestations as well as between clinical manifestations were also performed without any prior clustering.
Three separate autoantibody clusters were identified, each with significantly different clinical manifestations. Cluster 1 was characterized by anti-dsDNA and the greatest prevalence of renal disorder but the lowest frequencies of other clinical manifestations. Cluster 2 was represented by the predominance of anti-Smith, anti-RNP and aPL, with greater prevalence of malar rash, oral ulcers, arthritis and serositis. Cluster 3 was characterized by anti-Ro and anti-La with greater prevalence of discoid rash, photosensitivity and haematological involvement. Individual association analysis also revealed similar findings. Patients of clusters 2 and 3 were more closely related, while cluster 1 was more distinct, associated with renal disorder only and negatively associated or not associated with other manifestations.
We conclude that autoantibody clustering and clinical subsets exist in SLE patients of our locality. These clusters may be viewed as a bipolar spectrum of related autoantibody and clinical manifestations. At one end are patients with over-representation of anti-dsDNA and renal disorder, while at the other end are two distinct autoantibody clusters (anti-Sm/anti-RNP/aPL and anti-Ro/anti-La) with overlapping of other clinical manifestations.
本研究旨在识别中国系统性红斑狼疮（SLE）患者中自身抗体簇的存在及其与临床亚型的关系。
分析了来自香港的 1928 例 SLE 患者的数据。使用聚类分析，根据自身抗体将患者分为簇。然后比较每个簇之间各种临床表现的频率。还分别进行了个体自身抗体与临床表现以及临床表现之间的关联分析，而无需进行任何预先聚类。
确定了三个独立的自身抗体簇，每个簇都有明显不同的临床表现。簇 1 以抗 dsDNA 为特征，肾脏疾病的患病率最高，但其他临床表现的频率最低。簇 2 以抗 Smith、抗 RNP 和 aPL 为主，红斑、口腔溃疡、关节炎和浆膜炎的患病率更高。簇 3 以抗 Ro 和抗 La 为特征，盘状皮疹、光敏感和血液学受累的患病率更高。个体关联分析也得出了类似的发现。簇 2 和簇 3 的患者更为密切相关，而簇 1 更为独特，仅与肾脏疾病相关，与其他表现呈负相关或不相关。
我们得出结论，自身抗体聚类和临床亚型存在于我们地区的 SLE 患者中。这些簇可以看作是相关自身抗体和临床表现的双极谱。一端是抗 dsDNA 和肾脏疾病过度表达的患者，另一端是两个独特的自身抗体簇（抗 Sm/抗 RNP/aPL 和抗 Ro/抗 La），其他临床表现重叠。
