抗核抗体阴性的系统性红斑狼疮:有多少患者，如何鉴别?

IF 1.1 4区医学 Q4 Medicine

Archives of rheumatology Pub Date : 2022-12-01 DOI:10.46497/ArchRheumatol.2022.9366

Hejun Li, Yiqing Zheng, Ling Chen, Shunping Lin

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引用次数: 1

摘要

目的:本研究旨在通过大型单中心SLE初始队列研究，了解抗核抗体(ANA)阴性系统性红斑狼疮(SLE)的患病率及其临床特征，为早期诊断提供指导。患者与方法:2012年12月至2021年3月，共617例首发SLE患者(男性83例，女性534例;中位年龄[IQR]: 33+22.46岁)符合入选标准的患者进行回顾性分析。患者分为ana阴性SLE组和ana阳性SLE组，或长期使用糖皮质激素或免疫抑制剂组(SLE-1)和未使用SLE-0组。收集人口统计学、临床特征和实验室特征。结果:ana阴性SLE患者总患病率为2.11%(13/617)。SLE-1患者的ana阴性SLE患病率(7.46%)明显高于SLE-0患者(1.48%)。结论:SLE的ana阴性患病率虽然很低，但确实存在，特别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、低补体、抗dsdna阳性、中高滴度抗磷脂抗体(aPL)是ana阴性SLE的主要表现。在有风湿病症状，特别是血小板减少症的ana阴性患者中，有必要鉴定补体、抗dsdna和aPL。

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Antinuclear antibody-negative systemic lupus erythematosus: How many patients and how to identify?

Objectives: 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.

Patients and methods: 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.

Results: 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).

Conclusion: 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.

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来源期刊

Archives of rheumatology Medicine-Rheumatology

CiteScore

2.00

自引率

9.10%

发文量

期刊介绍： The Archives of Rheumatology is an official journal of the Turkish League Against Rheumatism (TLAR) and is published quarterly in March, June, September, and December. It publishes original work on all aspects of rheumatology and disorders of the musculoskeletal system. The priority of the Archives of Rheumatology is to publish high-quality original research articles, especially in inflammatory rheumatic disorders. In addition to research articles, brief reports, reviews, editorials, letters to the editor can also be published. It is an independent peer-reviewed international journal printed in English. Manuscripts are refereed by a "double-blind peer-reviewed" process for both referees and authors. Editorial Board of the Archives of Rheumatology works under the principles of The World Association of Medical Editors (WAME), the International Council of Medical Journal Editors (ICMJE), and Committee on Publication Ethics (COPE).