活动性肺结核中的自身抗体流行率：反应性还是特征性？
Autoantibody prevalence in active tuberculosis: reactive or pathognomonic?
机构信息
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
出版信息
BMJ Open. 2013 Jul 26;3(7). doi: 10.1136/bmjopen-2013-002665. Print 2013.
OBJECTIVES
To evaluate the autoantibody in patients without corresponding symptoms, whether these autoantibody are pathognomonic or not. We hypothesised that autoantibody may be reactive to chronic infection, such as tuberculosis (TB).
DESIGN
Randomised, case-control cohort study.
SETTING
A tertiary centre in Taiwan.
PARTICIPANTS
We randomly chose 100 patients out of the data bank of patients with TB in a tertiary medical centre. All patients completed the sera sampling. We chose 100 patients according to autoantibody prevalence in previous literature. We also chose 100 medical staff as control group.
INTERVENTIONS
We tested anti-SSA, anti-SSB, anti-Sm, anti ribonucleoprotein, anti-Scl 70, anticentromere, anti-double-stranded DNA, anticardiolipin IgG and IgM in all patient and control groups. The clinical symptoms and the underlying disease were all recorded.
PRIMARY AND SECONDARY OUTCOME MEASURES
The result of sera antibody titre was recorded. For those with specific positive serology results, following examination was carried out after a 3-month anti-TB medication.
RESULTS
Anticardiolipin IgG titre was significantly higher in patients with TB than in control group. We compared the result with previous population study and found that anti-Scl70 is also significantly higher in patients with TB. The following up data in anti-Scl70 revealed decreased titre after treatment. No correlation between sera titre and clinical conditions was observed.
CONCLUSIONS
In TB endemic areas, a significant proportion (32%) of patients with TB have elevated autoantibody titres, especially anticardiolipin IgG and anti-Scl-70. Mycobacterial studies should be performed in patients with elevated serum autoantibody titres but without the typical or multiple manifestations of autoimmune diseases.
TRIAL REGISTRATION
The study was approved by the Institutional Review Board of the hospital (NTUH REC: 9561707008) after informed consent had been obtained from the patients.
目的
评估无相应症状患者的自身抗体，这些自身抗体是否具有特征性。我们假设自身抗体可能与慢性感染（如结核病）反应有关。
设计
随机、病例对照队列研究。
地点
台湾一家三级中心。
参与者
我们从一家三级医疗中心的结核病患者数据库中随机选择了 100 名患者。所有患者均完成了血清取样。我们根据之前文献中的自身抗体患病率选择了 100 名患者。我们还选择了 100 名医务人员作为对照组。
干预措施
我们检测了所有患者和对照组的抗 SSA、抗 SSB、抗 Sm、抗核糖核蛋白、抗 Scl70、抗着丝点、抗双链 DNA、抗心磷脂 IgG 和 IgM。记录了临床症状和潜在疾病。
主要和次要结果测量
记录血清抗体滴度结果。对于具有特定阳性血清学结果的患者，在接受 3 个月抗结核药物治疗后进行了后续检查。
结果
结核病患者的抗心磷脂 IgG 滴度明显高于对照组。我们将结果与之前的人群研究进行了比较，发现结核病患者的抗 Scl70 滴度也明显升高。抗 Scl70 的随访数据显示，治疗后滴度降低。未观察到血清滴度与临床状况之间的相关性。
结论
在结核病流行地区，相当一部分（32%）结核病患者的血清自身抗体滴度升高，尤其是抗心磷脂 IgG 和抗 Scl-70。在血清自身抗体滴度升高但无自身免疫性疾病典型或多种表现的患者中，应进行分枝杆菌研究。
试验注册
在获得患者知情同意后，该研究经医院机构审查委员会（NTUH REC：9561707008）批准。
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