Kim Seong-Kyu, Choe Jung-Yoon, Kwak Sang Gyu
Division of Rheumatology, Department of Internal Medicine, Arthritis and Autoimmunity Research Center, Daegu Catholic University School of Medicine, Daegu, Korea.
Department of Medical Statistics, Daegu Catholic University School of Medicine, Daegu, Korea.
Int J Rheum Dis. 2019 Feb;22(2):191-199. doi: 10.1111/1756-185X.13430. Epub 2018 Nov 5.
The clinical importance of the anti-Ro antibody has not been completely understood. This study investigated identification of the association between mortality and clinical features in patients with autoimmune rheumatic diseases and detectable anti-Ro antibody titers.
We retrospectively analyzed a total of 336 patients with autoimmune rheumatic diseases and positive anti-Ro antibody titers from January 2012 to January 2015. Clinical manifestations and other autoantibodies detected during the follow-up period were identified. Cumulative survival rates were assessed by Kaplan-Meier analysis. Differences between survival curves for each risk factor were analyzed by log-rank test. The relative risk of mortality was assessed using standardized mortality ratios (SMRs).
There was no difference in the mortality rates of patients with autoimmune rheumatic diseases with or without detectable anti-Ro antibody (SMR: 1.373, 95% CI: 0.539-2.791). Six patients (4 with systemic lupus erythematosus [SLE] and two with Sjögren's syndrome [SS]) died during the follow-up period. In the whole study population, the mortality rate of patients with lymphopenia was higher than those without lymphopenia (P = 0.023). In a sub-group of patients with both SLE and SS, Kaplan-Meier analysis showed that lymphopenia and interstitial lung disease were associated with increased mortality (P = 0.024 and P = 0.023, respectively).
This study demonstrated that presence of the anti-Ro antibody was not associated with increased mortality in patients with autoimmune rheumatic disease. Conversely, we found that lymphopenia was independently associated with mortality in patients with autoimmune rheumatic disease.
抗Ro抗体的临床重要性尚未完全明确。本研究调查了自身免疫性风湿病且抗Ro抗体滴度可检测的患者中，死亡率与临床特征之间的关联。
我们回顾性分析了2012年1月至2015年1月期间共336例自身免疫性风湿病且抗Ro抗体滴度呈阳性的患者。确定随访期间的临床表现及检测到的其他自身抗体。采用Kaplan-Meier分析评估累积生存率。通过对数秩检验分析各危险因素生存曲线之间的差异。使用标准化死亡率（SMR）评估死亡的相对风险。
自身免疫性风湿病患者中，抗Ro抗体可检测或不可检测者的死亡率无差异（SMR：1.373，95%可信区间：0.539 - 2.791）。随访期间有6例患者死亡（4例系统性红斑狼疮[SLE]和2例干燥综合征[SS]）。在整个研究人群中，淋巴细胞减少患者的死亡率高于无淋巴细胞减少的患者（P = 0.023）。在SLE和SS并存的亚组患者中，Kaplan-Meier分析显示淋巴细胞减少和间质性肺疾病与死亡率增加相关（分别为P = 0.024和P = 0.023）。
本研究表明，抗Ro抗体的存在与自身免疫性风湿病患者死亡率增加无关。相反，我们发现淋巴细胞减少与自身免疫性风湿病患者的死亡率独立相关。
