Xu X F, Zhang J, Cui L, Wang Y H, Yue Y, Chi L, Bai J, Li H M, Lu X X
Department of Clinical Laboratory, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Zhonghua Yi Xue Za Zhi. 2017 Jan 24;97(4):285-290. doi: 10.3760/cma.j.issn.0376-2491.2017.04.010.
To investigate the value of HLA-B27 antigen, antinuclear antibody (ANA), anti-dsDNA and Anti-Neutrophil Cytoplasmic Antibodies (ANCA) detection in diagnosis of rheumatism with uveitis. Seven hundred and twenty four newly diagnosed patients with non-infection uveitis in Beijing Tongren Hospital from March 2012 to March 2016 who long-term lived in Beijing and its surrounding areas were continuously enrolled. HLA-B27 antigen expressions in peripheral blood lymphocytes and ANA, anti-dsDNA and ANCA levels in serum were tested. The detailed clinical data, imaging examinations and pathological examinations were recorded to define whether the patients had rheumatism and the types of rheumatism. There were 285 patients were diagnosed with rheumatism in 724 patients (39.4%), with 135 male (47.4%) and 150 female (52.6%). The mean age of male (41±14) was lower than that of female (44±14), with statistically significant (=2.18, <0.05). There were 176 patients with Spondyloarthropathies, 48 patients with primary systemic vasculitis, 22 patients with systemic lupus erythematosus, 18 patients with primary Sjogren's syndrome, 16 patients with rheumatoid arthritis and 5 patients with juvenile idiopathic arthritis in 285 rheumatism patients. The positive rate of HLA-B27(57.2%), ANA(15.8%), anti-dsDNA (5.3%) and ANCA(9.1%) in rheumatic uveitis patients were obviously higher than those of non-rheumatic uveitis patients [HLA-B27(1.1%), ANA(1.6%), anti-dsDNA (0.0%) and ANCA(0.9%)], with statistically significant ('<0.01). The HLA-B27 positive antigen were mainly in patients with Spondyloarthropathies, rate was 92.1%; the positive ANA were mainly in patients with systemic lupus erythematosus, rate was 95.5%; the positive anti-dsDNA were mainly in patients with systemic lupus erythematosus, rate was 59.1%; the positive ANCA were mainly in patients with primary systemic vasculitis (besides Behcet disease), rate was 57.1%. The detections of HLA-B27 antigen, ANA, anti-dsDNA and ANCA are valuable for primary screening of some rheumatic uveitis. There fore, clinicians should select targeted laboratory examination combine with the patients' clinical manifestations. This will be helpful in the auxiliary diagnosis of some types of rheumatic uveitis.
探讨人类白细胞抗原B27(HLA - B27)抗原、抗核抗体(ANA)、抗双链DNA抗体及抗中性粒细胞胞浆抗体(ANCA)检测在伴有葡萄膜炎的风湿病诊断中的价值。连续纳入2012年3月至2016年3月在北京同仁医院新诊断的724例非感染性葡萄膜炎患者,这些患者长期居住在北京及其周边地区。检测外周血淋巴细胞中HLA - B27抗原表达及血清中ANA、抗双链DNA抗体和ANCA水平。记录详细的临床资料、影像学检查及病理检查结果,以明确患者是否患有风湿病及风湿病类型。724例患者中有285例被诊断为风湿病(39.4%),其中男性135例(47.4%),女性150例(52.6%)。男性平均年龄(41±14)岁低于女性(44±14)岁,差异有统计学意义(=2.18,<0.05)。285例风湿病患者中,脊柱关节病176例,原发性系统性血管炎48例,系统性红斑狼疮22例,原发性干燥综合征18例,类风湿关节炎16例,幼年特发性关节炎5例。风湿性葡萄膜炎患者中HLA - B27(57.2%)、ANA(15.8%)、抗双链DNA抗体(5.3%)及ANCA(9.1%)的阳性率明显高于非风湿性葡萄膜炎患者[HLA - B27(1.1%)、ANA(1.6%)、抗双链DNA抗体(0.0%)及ANCA(0.9%)],差异有统计学意义('<0.01)。HLA - B27阳性抗原主要见于脊柱关节病患者,阳性率为92.1%;ANA阳性主要见于系统性红斑狼疮患者,阳性率为95.5%;抗双链DNA抗体阳性主要见于系统性红斑狼疮患者,阳性率为59.1%;ANCA阳性主要见于原发性系统性血管炎(不包括白塞病)患者,阳性率为57.1%。HLA - B27抗原、ANA、抗双链DNA抗体及ANCA检测对某些风湿性葡萄膜炎的初步筛查有价值。因此,临床医生应结合患者临床表现选择针对性的实验室检查,这将有助于某些类型风湿性葡萄膜炎的辅助诊断。