Li Hejun, Zheng Yiqing, Chen Ling, Lin Shunping
Department of Rheumatology, Fujian Medical University Union Hospital, Fuzhou, China.
Arch Rheumatol. 2022 Sep 20;37(4):626-634. doi: 10.46497/ArchRheumatol.2022.9366. eCollection 2022 Dec.
This study aims to the prevalence of antinuclear antibody (ANA)-negative systemic lupus erythematosus (SLE) and their clinical characteristics in a large single-center SLE inception cohort to provide guidance for early diagnosis.
Between December 2012 and March 2021, the medical records of a total of 617 firstly diagnosed SLE patients (83 males, 534 females; median age [IQR]: 33+22.46 years) who fulfilled the selection criteria were retrospectively analyzed. The patients were divided into groups with ANA-negative SLE and ANA-positive SLE, or with prolonged use of glucocorticoids or immunosuppressants (SLE-1) and without (SLE-0). Demographic, clinical characteristics, and laboratory features were collected.
The total prevalence of ANA-negative SLE patients was 2.11% (13/617). The prevalence of ANA-negative SLE in SLE-1 (7.46%) was significantly higher than that in SLE-0 (1.48%) (p<0.01). The ANA-negative SLE patients had a higher prevalence of thrombocytopenia (84.62%) than ANA-positive SLE patients (34.27%). As with ANA-positive SLE, ANA-negative SLE also had a high prevalence of low complement (92.31%) and anti-double-stranded deoxyribonucleic acid (anti-dsDNA) positivity (69.23%). The prevalence of medium-high titer anti-cardiolipin antibody (aCL) IgG (50.00%) and anti-ß2 glycoprotein I (anti-ß2GPI) (50.00%) of ANA-negative SLE was significantly higher than that of ANA-positive SLE (11.22% and 14.93%, respectively).
The prevalence of ANA-negative SLE is very low, but it exists, particularly under the influence of prolonged use of glucocorticoids or immunosuppressants. Thrombocytopenia, low complement, positive anti-dsDNA, and medium-high titer antiphospholipid antibody (aPL) are the main manifestations of ANA-negative SLE. It is necessary to identify complement, anti-dsDNA, and aPL in ANA-negative patients with rheumatic symptoms, particularly thrombocytopenia.
本研究旨在调查在一个大型单中心系统性红斑狼疮（SLE）起始队列中抗核抗体（ANA）阴性的SLE的患病率及其临床特征，以为早期诊断提供指导。
回顾性分析了2012年12月至2021年3月期间共617例符合入选标准的初诊SLE患者（83例男性，534例女性；年龄中位数[IQR]：33 + 22.46岁）的病历。将患者分为ANA阴性SLE组和ANA阳性SLE组，或分为长期使用糖皮质激素或免疫抑制剂组（SLE-1）和未使用组（SLE-0）。收集了人口统计学、临床特征和实验室检查结果。
ANA阴性SLE患者的总患病率为2.11%（13/617）。SLE-1组中ANA阴性SLE的患病率（7.46%）显著高于SLE-0组（1.48%）（p<0.01）。ANA阴性SLE患者血小板减少症的患病率（84.62%）高于ANA阳性SLE患者（34.27%）。与ANA阳性SLE一样，ANA阴性SLE低补体血症（92.31%）和抗双链脱氧核糖核酸（抗dsDNA）阳性（69.23%）的患病率也很高。ANA阴性SLE中、高滴度抗心磷脂抗体（aCL）IgG（50.00%）和抗β2糖蛋白I（抗β2GPI）（50.00%）的患病率显著高于ANA阳性SLE（分别为11.22%和14.93%）。
ANA阴性SLE的患病率非常低，但确实存在，尤其是在长期使用糖皮质激素或免疫抑制剂的影响下。血小板减少症、低补体血症、抗dsDNA阳性和中、高滴度抗磷脂抗体（aPL）是ANA阴性SLE的主要表现。对于有风湿症状，特别是血小板减少症的ANA阴性患者，有必要检测补体、抗dsDNA和aPL。
