Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Brazil.
Clin Exp Rheumatol. 2018 Nov-Dec;36(6 Suppl 115):28-32. Epub 2018 Feb 7.
To assess IgM anti-alpha-enolase antibodies (AAEA) in systemic Behçet's disease (BD) and its possible association with clinical manifestations and disease activity.
Ninety-seven consecutively selected BD patients were compared to 36 enteropathic spondyloarthritis (ESpA) [24 Crohn's disease (CD) and 12 ulcerative colitis (UC)] patients and 87 healthy controls. IgM AAEA was detected by immunoblotting. Disease activity was assessed by standardised indexes, Brazilian BD Current Activity Form (BR-BDCAF) for BD and Harvey-Bradshaw Index (HBI) for CD and UC patients. A second evaluation was performed in BD patients (n=56), regarding IgM AAEA presence, disease activity scores and C-reactive protein (CRP).
Higher IgM AAEA prevalence was found in 97 BD (17.7%) compared to ESpA (2.8%) and healthy controls (2.3%), p<0.001. IgM AAEA frequency was higher in active BD compared to inactive BD (30.2% vs. 7.4%, p=0.006), a finding confirmed in the second cross-sectional evaluation of 56 of these BD patients (45.5% vs. 13.3%, p=0.02). Mean BR-BDCAF scores were higher in IgM AAEA positive group on both evaluations (9.1 ± 5.4 vs. 4.9 ± 4.9, p=0.002; 5.0 ± 4.9 vs. 2.2 ± 2.9, p=0.01, respectively). BD patients with mucocutaneous and articular symptoms presented higher IgM AAEA positivity in the first and second evaluations (64.7% vs. 27.5%, p=0.005; 36.4% vs. 7.1%, p=0.039 respectively).
Our data support the notion that alpha-enolase is a target antigen in BD, particularly associated with disease activity, mucocutaneous and articular involvement. In addition, IgM AAEA may distinguish BD from ESpA, especially in patients with high disease activity.
评估系统性贝赫切特病（BD）患者血清 IgM 抗α-烯醇化酶抗体（AAEA），并分析其与临床特征和疾病活动度的关系。
本研究共纳入 97 例连续选择的 BD 患者，36 例肠病性脊柱关节炎（ESpA）[24 例克罗恩病（CD）和 12 例溃疡性结肠炎（UC）]患者和 87 名健康对照者。采用免疫印迹法检测 IgM AAEA。采用标准评分评估疾病活动度，BD 患者采用巴西贝赫切特病活动评分表（BR-BDCAF），CD 和 UC 患者采用 Harvey-Bradshaw 指数（HBI）。对 56 例 BD 患者（n=56）进行了 IgM AAEA 存在、疾病活动评分和 C 反应蛋白（CRP）的二次评估。
97 例 BD 患者中 IgM AAEA 阳性率（17.7%）显著高于 ESpA（2.8%）和健康对照组（2.3%）（p<0.001）。与活动期 BD 相比，静止期 BD 患者的 IgM AAEA 阳性率更低（30.2% vs. 7.4%，p=0.006），对这 56 例 BD 患者进行的二次横断面评估结果也证实了这一点（45.5% vs. 13.3%，p=0.02）。两次评估中，IgM AAEA 阳性组的 BR-BDCAF 评分均较高（均 p<0.001），第一次评估中为（9.1 ± 5.4）分 vs. （4.9 ± 4.9）分，第二次评估中为（5.0 ± 4.9）分 vs. （2.2 ± 2.9）分。第一次和第二次评估中，有黏膜皮肤和关节症状的 BD 患者 IgM AAEA 阳性率均较高（均 p<0.05），第一次评估中为 64.7% vs. 27.5%，第二次评估中为 36.4% vs. 7.1%。
我们的数据支持α-烯醇化酶是 BD 的一种靶抗原的观点，尤其是与疾病活动度、黏膜皮肤和关节受累相关。此外，IgM AAEA 可能有助于将 BD 与 ESpA 区分开来，尤其是在疾病活动度较高的患者中。
