Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy.
Institute of Clinical Physiology, National Research Council, Pisa, Italy.
J Eur Acad Dermatol Venereol. 2019 Apr;33(4):742-752. doi: 10.1111/jdv.15147. Epub 2018 Jul 12.
Anti-nuclear antibodies (ANA), anti-extractable nuclear antigens (ENA) and anti-dsDNA antibodies are often associated with cutaneous lupus erythematosus (CLE), with variable frequency depending on skin subtype. However, specific data based on large case-series on the pathogenetic, diagnostic and prognostic meaning of such autoantibodies are still lacking.
To characterize the correlations between CLE subtypes as well as LE-non-specific skin lesions and their autoantibody pattern.
Epidemiological, clinical and immunopathological data of 619 Italian patients with CLE and LE-non-specific skin lesions were analysed. Differences in age, sex, clinical features and autoantibody profile were evaluated in each LE subgroup.
Anti-nuclear antibodies (P < 0.0001), anti-dsDNA (P < 0.0001), ENA (P = 0.001), anti-Sm (P = 0.001), anti-RNP (P = 0.004) and anti-histone (P = 0.005) antibodies were associated with SLE. A strong association between ANA (P < 0.0001) and anti-dsDNA (P < 0.0001) and female gender was also found: positive ANA and positive anti-dsDNA had a higher prevalence among females. Chronic CLE resulted to be negatively associated with ENA (OR = 0.51, P < 0.0001), anti-Ro/SSA (OR = 0.49, P < 0.0001) and anti-dsDNA (OR = 0.37, P < 0.0001). Intermittent CLE resulted to be negatively associated with ENA (OR = 0.50, P = 0.007) and ANA (OR = 0.61, P = 0.025). Subacute CLE resulted to be associated with ENA (OR = 5.19, P < 0.0001), anti-Ro/SSA (OR = 3.83, P < 0.0001), anti-Smith (OR = 2.95, P = 0.004) and anti-RNP (OR = 3.18, P = 0.007). Acute CLE resulted to be strongly associated with anti-dsDNA (OR = 6.0, P < 0.0001) and ANA (OR = 18.1, P < 0.0001). LE-non-specific skin lesions resulted to be significantly associated with systemic involvement. Livedo reticularis was significantly associated with ENA (P = 0.007) and anti-Ro/SSA (P = 0.036). Palpable purpura and periungual telangiectasia were significantly associated with ANA.
According to our findings, some well-known associations between CLE subtypes and autoantibody profile were confirmed; moreover, specific association between autoantibodies and LE-non-specific skin lesions was highlighted. A strict association between anti-ENA and anti-Ro/SSA antibodies and livedo reticularis, ANA and palpable purpura, and ANA and periungual telangiectasia was evidenced.
抗核抗体（ANA）、抗可提取核抗原（ENA）和抗双链 DNA 抗体常与皮肤红斑狼疮（CLE）相关，其频率取决于皮肤亚型。然而，基于大型病例系列的此类自身抗体在发病机制、诊断和预后意义方面的具体数据仍然缺乏。
描述 CLE 亚型以及 LE 非特异性皮肤病变与其自身抗体模式之间的相关性。
分析了 619 例意大利 CLE 和 LE 非特异性皮肤病变患者的流行病学、临床和免疫病理学数据。评估了每个 LE 亚组之间的年龄、性别、临床特征和自身抗体谱的差异。
ANA（P < 0.0001）、抗 dsDNA（P < 0.0001）、ENA（P = 0.001）、抗 Sm（P = 0.001）、抗 RNP（P = 0.004）和抗组蛋白（P = 0.005）抗体与系统性红斑狼疮（SLE）相关。ANA（P < 0.0001）和抗 dsDNA（P < 0.0001）与女性之间也存在强烈关联：ANA 和抗 dsDNA 阳性在女性中更为常见。慢性 CLE 与 ENA（OR = 0.51，P < 0.0001）、抗 Ro/SSA（OR = 0.49，P < 0.0001）和抗 dsDNA（OR = 0.37，P < 0.0001）呈负相关。间歇性 CLE 与 ENA（OR = 0.50，P = 0.007）和 ANA（OR = 0.61，P = 0.025）呈负相关。亚急性 CLE 与 ENA（OR = 5.19，P < 0.0001）、抗 Ro/SSA（OR = 3.83，P < 0.0001）、抗 Smith（OR = 2.95，P = 0.004）和抗 RNP（OR = 3.18，P = 0.007）相关。急性 CLE 与抗 dsDNA（OR = 6.0，P < 0.0001）和 ANA（OR = 18.1，P < 0.0001）呈强相关。LE 非特异性皮肤病变与全身受累显著相关。网状青斑与 ENA（P = 0.007）和抗 Ro/SSA（P = 0.036）显著相关。可触及性紫癜和甲周毛细血管扩张与 ANA 显著相关。
根据我们的发现，证实了 CLE 亚型与自身抗体谱之间的一些已知关联；此外，还强调了自身抗体与 LE 非特异性皮肤病变之间的特定关联。ANA 和抗 Ro/SSA 抗体与网状青斑、ANA 和可触及性紫癜、ANA 和甲周毛细血管扩张之间存在密切关联。
