抗内皮素1 A型受体自身抗体是系统性硬化症中手指溃疡的强预测指标。
Autoantibodies against Endothelin 1 Type A Receptor Are Strong Predictors of Digital Ulcers in Systemic Sclerosis.
作者信息
Avouac Jérôme, Riemekasten Gabriela, Meune Christophe, Ruiz Barbara, Kahan André, Allanore Yannick
机构信息
From the Paris Descartes University, Sorbonne Paris Cité, Rheumatology A Department, Cochin Hospital; Paris Descartes University, Institut National de la Santé Et de la Recherche Médicale, Unité 1016 (INSERM U1016), and Centre National de la Recherche Scientifique, Unité Mixte de Recherche 8104 (CNRS UMR8104), Cochin Institute; Paris 13 University, University Hospital of Paris-Seine-Saint-Denis, Cardiology Department, Bobigny, France and Unité Mixte de Recherche 942 (UMR 942), Paris, France; Department of Rheumatology, Clinical Immunology, and German Rheumatism Research Centre, a Leibniz institute, Charité-University Medicine, Berlin, Germany.J. Avouac, MD, PhD, Paris Descartes University, Sorbonne Paris Cité, Rheumatology A department, Cochin Hospital, and Paris Descartes University, INSERM U1016, and CNRS UMR8104, Cochin Institute; G. Riemekasten, MD, PhD, Department of Rheumatology, Clinical Immunology, and German Rheumatism Research Centre, a Leibniz institute, Charité-University Medicine; C. Meune, MD, PhD, Paris 13 University, University Hospital of Paris-Seine-Saint-Denis, Cardiology Department, and UMR 942; B. Ruiz, Assistant Ingenior, Paris Descartes University, INSERM U1016, and CNRS UMR8104, Cochin Institute; A. Kahan, MD, PhD, Paris Descartes University, Sorbonne Paris Cité, Rheumatology A department, Cochin Hospital; Y. Allanore, MD, PhD, Paris Descartes University, Sorbonne Paris Cité, Rheumatology A department, Cochin Hospital, and Paris Descartes University, INSERM U1016, and CNRS UMR8104, Cochin Institute.
出版信息
J Rheumatol. 2015 Oct;42(10):1801-7. doi: 10.3899/jrheum.150061. Epub 2015 Aug 1.
OBJECTIVE
To determine the predictive value of functional autoantibodies against vascular receptors for the development of ischemic digital ulcers (DU) in patients with systemic sclerosis (SSc).
METHODS
Angiotensin II Type 1 receptor (AT1R) and endothelin 1 Type A receptor (ETAR) autoantibodies were measured at baseline in a prospective cohort of 90 patients with SSc together with 5 validated angiogenic markers. The primary outcome was the occurrence of at least 1 new ischemic DU during the 5-year followup.
RESULTS
Twenty-four patients developed at least 1 new DU during the followup period. Univariate Cox analysis revealed that concentrations above the median value of anti-AT1R and anti-ETAR antibodies were predictive of the occurrence of ischemic DU (HR 2.85, 95% CI 1.19-6.84 and HR 3.39, 95% CI 1.35-8.50, respectively). A first multivariate Cox analysis including functional autoantibodies and clinical predictors of new DU confirmed anti-ETAR autoantibodies as independent predictors of the occurrence of new ischemic DU (HR 3.15, 95% CI 1.22-8.13) together with a history of DU at baseline. In a second model implemented with angiogenic markers, anti-ETAR autoantibodies remained an independent predictor of the occurrence of new ischemic DU (HR 9.59, 95% CI 1.75-52.64) together with the presence at baseline of active DU or history of DU.
CONCLUSION
Anti-ETAR autoantibodies can be used together with the presence of current or past DU to identify patients with SSc who are at risk for the development of subsequent DU. These autoantibodies may allow for earlier management and therapeutic intervention.
目的
确定针对血管受体的功能性自身抗体对系统性硬化症（SSc）患者缺血性指端溃疡（DU）发生的预测价值。
方法
在一个前瞻性队列中，对90例SSc患者在基线时检测血管紧张素II 1型受体（AT1R）和内皮素1 A型受体（ETAR）自身抗体以及5种经过验证的血管生成标志物。主要结局是在5年随访期间至少出现1个新的缺血性DU。
结果
24例患者在随访期间至少出现1个新的DU。单因素Cox分析显示，抗AT1R和抗ETAR抗体浓度高于中位数可预测缺血性DU的发生（HR分别为2.85，95%CI 1.19 - 6.84和HR 3.39，95%CI 1.35 - 8.50）。首次多因素Cox分析纳入功能性自身抗体和新DU的临床预测因素，证实抗ETAR自身抗体是新缺血性DU发生的独立预测因素（HR 3.15，95%CI 1.22 - 8.13），同时基线时有DU病史。在第二个纳入血管生成标志物的模型中，抗ETAR自身抗体仍然是新缺血性DU发生的独立预测因素（HR 9.59，95%CI 1.75 - 52.64），同时基线时有活动性DU或DU病史。
结论
抗ETAR自身抗体可与当前或既往DU的存在情况一起用于识别有发生后续DU风险的SSc患者。这些自身抗体可能有助于早期管理和治疗干预。
Zotero 插件