中华风湿病学杂志
中華風濕病學雜誌
중화풍습병학잡지
CHINESE JOURNAL OF RHEUMATOLOGY
2013年
1期
10-15
,共6页
杨阚波%舒晓明%彭清林%王艳%王国春%卢昕
楊闞波%舒曉明%彭清林%王豔%王國春%盧昕
양감파%서효명%팽청림%왕염%왕국춘%로흔
多发性肌炎%皮肌炎%肿瘤,继发原发性%抗转录中介因子1-γ抗体
多髮性肌炎%皮肌炎%腫瘤,繼髮原髮性%抗轉錄中介因子1-γ抗體
다발성기염%피기염%종류,계발원발성%항전록중개인자1-γ항체
Polymyositis%Dermatomyositis%Neoplasms,second primary%Anti-transcriptional intermediary factor 1-γ antibody
目的 探讨抗转录中介因子(TIF)1-γ抗体在多发性肌炎/皮肌炎患者血清中的分布状况及其在多发性肌炎/皮肌炎合并肿瘤早期诊断中的价值.方法 多发性肌炎和皮肌炎患者共146例[多发性肌炎50例,皮肌炎96例,其他结缔组织病组95例[系统性红斑狼疮(SLE) 33例,类风湿关节炎(RA)54例,硬皮病(SSc)8例)].健康对照40名.免疫沉淀非标记抗原法检测血清抗TIF1-y抗体,分析该抗体在各组疾病中的阳性率及其与肌炎合并肿瘤的相关性.采用t检验,Mann-Wittney U检验,x2检验及Fisher确切概率法进行统计学分析.结果 96例皮肌炎患者中共有17例(18％)患者抗TIF1-γ抗体阳性,阳性率为18％,其中典型皮肌炎5例(7％),儿童皮肌炎1例(17％),无肌病性皮肌炎2例(25％),皮肌炎合并恶性肿瘤9例(64％)；50例多发性肌炎中仅有1例阳性(2％)；其余结缔组织病和健康对照组均为阴性.14例肌炎合并肿瘤患者均为皮肌炎患者.血清抗TIF1-γ抗体在皮肌炎合并肿瘤中的阳性率为64％,在皮肌炎不合并肿瘤中的阳性率为7％,与皮肌炎合并肿瘤呈正相关(OR=17.74,95％CI 5.7～55.4)；其诊断皮肌炎合并肿瘤敏感性为64.3％,特异性为92.7％,阳性预测值为56.3％,阴性预测值为90.8％.抗 TIF1-γ抗体阳性的患者发病年龄显著高于阴性组,差异有统计学意义(P＜0.01),与抗TIF1-γ抗体阴性组相比,抗体阳性组合并肺间质疾病的发生率低(P＜0.01),伴发V字疹的阳性率高(P＜0.05),差异均有统计学意义.结论 血清抗TIF1-γ抗体是皮肌炎合并肿瘤敏感和特异的血清学指标,它为筛查皮肌炎合并肿瘤提供有效的手段,对于皮肌炎的患者可在确诊的同时检测抗TIF1-γ抗体,可用于早期诊断肿瘤,对改善预后有重要的意义.
目的 探討抗轉錄中介因子(TIF)1-γ抗體在多髮性肌炎/皮肌炎患者血清中的分佈狀況及其在多髮性肌炎/皮肌炎閤併腫瘤早期診斷中的價值.方法 多髮性肌炎和皮肌炎患者共146例[多髮性肌炎50例,皮肌炎96例,其他結締組織病組95例[繫統性紅斑狼瘡(SLE) 33例,類風濕關節炎(RA)54例,硬皮病(SSc)8例)].健康對照40名.免疫沉澱非標記抗原法檢測血清抗TIF1-y抗體,分析該抗體在各組疾病中的暘性率及其與肌炎閤併腫瘤的相關性.採用t檢驗,Mann-Wittney U檢驗,x2檢驗及Fisher確切概率法進行統計學分析.結果 96例皮肌炎患者中共有17例(18％)患者抗TIF1-γ抗體暘性,暘性率為18％,其中典型皮肌炎5例(7％),兒童皮肌炎1例(17％),無肌病性皮肌炎2例(25％),皮肌炎閤併噁性腫瘤9例(64％)；50例多髮性肌炎中僅有1例暘性(2％)；其餘結締組織病和健康對照組均為陰性.14例肌炎閤併腫瘤患者均為皮肌炎患者.血清抗TIF1-γ抗體在皮肌炎閤併腫瘤中的暘性率為64％,在皮肌炎不閤併腫瘤中的暘性率為7％,與皮肌炎閤併腫瘤呈正相關(OR=17.74,95％CI 5.7～55.4)；其診斷皮肌炎閤併腫瘤敏感性為64.3％,特異性為92.7％,暘性預測值為56.3％,陰性預測值為90.8％.抗 TIF1-γ抗體暘性的患者髮病年齡顯著高于陰性組,差異有統計學意義(P＜0.01),與抗TIF1-γ抗體陰性組相比,抗體暘性組閤併肺間質疾病的髮生率低(P＜0.01),伴髮V字疹的暘性率高(P＜0.05),差異均有統計學意義.結論 血清抗TIF1-γ抗體是皮肌炎閤併腫瘤敏感和特異的血清學指標,它為篩查皮肌炎閤併腫瘤提供有效的手段,對于皮肌炎的患者可在確診的同時檢測抗TIF1-γ抗體,可用于早期診斷腫瘤,對改善預後有重要的意義.
목적 탐토항전록중개인자(TIF)1-γ항체재다발성기염/피기염환자혈청중적분포상황급기재다발성기염/피기염합병종류조기진단중적개치.방법 다발성기염화피기염환자공146례[다발성기염50례,피기염96례,기타결체조직병조95례[계통성홍반랑창(SLE) 33례,류풍습관절염(RA)54례,경피병(SSc)8례)].건강대조40명.면역침정비표기항원법검측혈청항TIF1-y항체,분석해항체재각조질병중적양성솔급기여기염합병종류적상관성.채용t검험,Mann-Wittney U검험,x2검험급Fisher학절개솔법진행통계학분석.결과 96례피기염환자중공유17례(18％)환자항TIF1-γ항체양성,양성솔위18％,기중전형피기염5례(7％),인동피기염1례(17％),무기병성피기염2례(25％),피기염합병악성종류9례(64％)；50례다발성기염중부유1례양성(2％)；기여결체조직병화건강대조조균위음성.14례기염합병종류환자균위피기염환자.혈청항TIF1-γ항체재피기염합병종류중적양성솔위64％,재피기염불합병종류중적양성솔위7％,여피기염합병종류정정상관(OR=17.74,95％CI 5.7～55.4)；기진단피기염합병종류민감성위64.3％,특이성위92.7％,양성예측치위56.3％,음성예측치위90.8％.항 TIF1-γ항체양성적환자발병년령현저고우음성조,차이유통계학의의(P＜0.01),여항TIF1-γ항체음성조상비,항체양성조합병폐간질질병적발생솔저(P＜0.01),반발V자진적양성솔고(P＜0.05),차이균유통계학의의.결론 혈청항TIF1-γ항체시피기염합병종류민감화특이적혈청학지표,타위사사피기염합병종류제공유효적수단,대우피기염적환자가재학진적동시검측항TIF1-γ항체,가용우조기진단종류,대개선예후유중요적의의.
Objective To identify the prevalence of anti-transcriptional intermediary factor (TIF)1-γ antibody in Chinese patients with idiopathic inflammatory myositis and to define its role in the assessment of early diagnosis of cancer associated myositis (CAM) in a large cohort.Methods Sera from 96 Chinese patients with dermatomyositis(DM),50 patients with polymyositis (PM),33 patients with systemic lupus erythem-atosus (SLE),54 patients with rheumatoid arthritis (RA),8 patients with systemic sclerosis (SSc),and 40 healthy controls were examined by immunoprecipitation assays followed by Western blotting.The distribution of these antibodies in each group was assessed and the association between this autoantibody and CAM in a large cohort was further revealed.T test,Mann-Wittney U test,Chi-square test and Fisher exact test were used for statistical analysis.Results Sera from 17 of 96 DM patients (18％),including 1 with juvenile dermatomyositis (JDM) (17％),2 with clinical amyopathic dermatomyositis (CADM) (25％),and 9 with CAM (64％) were found to have anti-TIF1-γ antibody by immunoprecipitation assays followed by Western blotting.Only 1 patient with PM (2％) was observed with anti-TIF1-γ autoantibody,and no patients with other connective tissue disease patients as well as healthy controls were positive for this autoantibody.The risk of -developing CAM in anti-TIF1γ-positive patients was significantly increased compared to the anti-TIF1-γnegative group,with an OR of 17.74 (95％CI,5.68-55.40).In DM,the negative and positive predictive value of anti-TIF1-γ autoantibody for the diagnosis of CAM was 90.8％ and 56.3％,respectively.Anti-TIF1γ-positive DM patients were significantly older than anti-TIF1-γ-negative DM patients (63±11 vs 48 ±14,P＜0.01).Notably,three of the anti-TIF1γ-positive patients had ILD,one patient was classified as having CAM and the other two were DM patients without cancer,but anti-TIF1γ-positive patients still had a significantly lower incidence of interstitial lung disease (19％ vs 54％,P＜0.05).In contrast to anti-TIF1-γγ-negative DM patients,anti-TIF1-γ antibody-positive patients were more frequently (81％ vs 50％,P＜0.01).There was no significant difference between these groups in terms of other clinical and laboratory parameters.Conclusion Anti-TIF1-γ antibodies may act as a useful diagnostic serological marker for early diagnosis of CAM in Chinese patients.For patients with DM,anti-TIF1-γ antibodies should be assessed at the time of disease diagnosis.This antibody may have impo-rtant significance in the early diagnosis of tumor and improving prognosis.
