抗SSB抗体阳性与阴性的原发性干燥综合征患者的临床及免疫学特征比较
[Comparison of clinical and immunological characteristics between primary Sjögren's syndrome patients with positive and negative anti-SSB antibody].
作者信息
Han Yi Jun, Li Chang Hong, Chen Xiu Ying, Zhao Jin Xia
机构信息
Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China.
Department of Internal Medicine, Yanqing Hospital, Peking University Third Hospital, Beijing 102100, China.
出版信息
Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Dec 18;55(6):1000-1006. doi: 10.19723/j.issn.1671-167X.2023.06.007.
OBJECTIVE
To analyze the differences of clinical manifestations and laboratory features between primary Sjögren's syndrome (pSS) patients with positive and negative anti-Sjögren's syndrome type B (SSB) antibody.
METHODS
The clinical data of pSS patients hospitalized in Department of Rheumato-logy and Immunology, Peking University Third Hospital were retrospectively analyzed to investigate the differences of clinical and laboratory features between anti-SSB positive and negative groups. The test, Mann-Whitney test, Chi-square test and Fisher's exact probability were used for analysis.
RESULTS
A total of 142 pSS patients were enrolled in this study, including 137 females and 5 males with a mean age of (54.8±13.3) years. The anti-SSB positive group included 44 patients accounting for 31.0% of the pSS patients. The anti-SSB positive pSS patients were younger at disease onset and at visit [age at visit: (50.9±14.5) years (56.5±12.4) years; age at onset: (42.2±14.8) years . (49.5±15.3) years, < 0.05]. The patients with anti-SSB positive more frequently presented with rash (29.5% . 14.3%, < 0.05), enlargement of parotid glands (27.3% . 8.2%, < 0.05), renal tubular acidosis (15.9% . 4.2%, < 0.05), immune thrombocytopenia (9.1% . 1.0%, < 0.05), rheumatoid factor (RF) positive (85.0% . 49.4%, < 0.05), higher RF and antinuclear antibody (ANA) titers (median: 89.8 IU/mL . 20.5 IU/mL; median: 320 . 160, < 0.05), anti-Sjögren's syndrome type A (SSA) antibody positive (97.7% . 64.3%, < 0.05), elevation of γ globulin (71.4% . 38.5%, < 0.05), higher levels of IgG (median: 21.0 g/L . 15.6 g/L, < 0.05), higher proportions of CD3CD19 cells [(21.0±11.9)% . (13.7±9.6)%, < 0.05] and lower proportions of CD3 cells [(67.2±14.4)% . (76.6%±13.1)%, < 0.05] than those negative. However, the anti-SSB positive group was less likely to show anti-mitochondrial antibodies (AMA)-M2 positivity (10.5% . 35.6%, < 0.05). Glucocorticoids (90.9% . 73.5%, < 0.05) and immunosuppressants (54.5% . 36.7%, < 0.05) were more frequently used in anti-SSB positive pSS patients than those negative.
CONCLUSION
The anti-SSB positive pSS patients were younger at disease onset while more frequently presenting with various symptoms, higher levels of other antibodies and activation of B cells than those negative. Glucocorticoids and immunosuppressants were more frequently used, indicating that anti-SSB positive group presented with a more severe clinal phenotype.
目的
分析抗干燥综合征B型（SSB）抗体阳性与阴性的原发性干燥综合征（pSS）患者的临床表现及实验室特征差异。
方法
回顾性分析北京大学第三医院风湿免疫科住院的pSS患者的临床资料，探讨抗SSB阳性组与阴性组的临床及实验室特征差异。采用t检验、Mann-Whitney检验、卡方检验和Fisher确切概率法进行分析。
结果
本研究共纳入142例pSS患者，其中女性137例，男性5例，平均年龄（54.8±13.3）岁。抗SSB阳性组44例，占pSS患者的31.0%。抗SSB阳性的pSS患者发病时及就诊时年龄更小[就诊时年龄：（50.9±14.5）岁对（56.5±12.4）岁；发病时年龄：（42.2±14.8）岁对（49.5±15.3）岁，P<0.05]。抗SSB阳性患者皮疹（29.5%对14.3%，P<0.05）、腮腺肿大（27.3%对8.2%，P<0.05）、肾小管酸中毒（15.9%对4.2%，P<0.05）、免疫性血小板减少症（9.1%对1.0%，P<0.05）、类风湿因子（RF）阳性（85.0%对49.4%，P<0.05）的发生率更高，RF及抗核抗体（ANA）滴度更高（中位数：89.8 IU/mL对20.5 IU/mL；中位数：320对160，P<0.05），抗干燥综合征A型（SSA）抗体阳性（97.7%对64.3%，P<0.05），γ球蛋白升高（71.4%对38.5%，P<0.05），IgG水平更高（中位数：21.0 g/L对15.6 g/L，P<0.05），CD3⁺CD19⁺细胞比例更高[（21.0±11.9）%对（13.7±9.6）%，P<0.05]，CD3⁺细胞比例更低[（67.2±14.4）%对（76.6%±13.1）%，P<0.05]。然而，抗SSB阳性组抗线粒体抗体（AMA）-M2阳性的可能性较小（10.5%对35.6%，P<0.05）。抗SSB阳性的pSS患者比阴性患者更频繁使用糖皮质激素（90.9%对73.5%，P<0.05）和免疫抑制剂（54.5%对36.7%，P<0.05）。
结论
抗SSB阳性的pSS患者发病年龄更小，与阴性患者相比，出现各种症状的频率更高，其他抗体水平更高，B细胞活化更明显。糖皮质激素和免疫抑制剂的使用更频繁，表明抗SSB阳性组表现出更严重的临床表型。
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