摘要
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-γ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,X^2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TIFf．1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％CI5．7．55．4）；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（段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。
Objective To identify the prevalence of anti-transcriptional intermediary factor （TIF）1-＇y 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 amyopathie 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-TIFl-3, 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-γ neg- ative 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-TIFγ-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-TIFl＇y-positive patients still had a significantly lower incidence of interstitial lung disease （ 19% vs 54%, P〈0.05）. In contrast to anti-TIFl-＇y-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-TIF1γ 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.
出处
《中华风湿病学杂志》
CAS
CSCD
北大核心
2013年第1期10-15,共6页
Chinese Journal of Rheumatology
基金
北京市科委资助项目（Z111107058811084）
关键词
多发性肌炎
皮肌炎
肿瘤
继发原发性
抗转录中介因子1
吖抗体
Polymyositis
Dermatomyositis
Neoplasms, second primary
Anti-transcriptionalintermediary factor 1-γantibody
