摘要
目的观察银屑病患者接受抗肿瘤坏死因子α制剂治疗后抗核抗体（ANA）、抗dsDNA抗体和抗可提取性核抗原（ENA）抗体的变化。方法回顾分析32例银屑病患者，其中13例使用英夫利西单抗治疗，19例使用依那西普治疗。英夫利西单抗组第0、2、6周各用药1次，此后每隔8周用药，于每次用药前检测患者ANA、抗dsDNA抗体及ENA的情况和临床症状的变化。依那西普组每周用药2次，每3～6个月检测患者ANA、抗dsDNA抗体及ENA的情况和临床症状的变化。采用银屑病皮损面积和严重度指数（PASI）75、疾病活动评分（DAS）2S评估临床疗效，间接免疫荧光法检测血清ANA水平，免疫印迹法和ELISA法检测抗dsDNA抗体水平，免疫印迹法检测抗ENA抗体水平。结果32例银屑病患者临床症状有不同程度缓解。32例抗TNF-α治疗的患者中有7例（21．9％）出现自身抗体，其中英夫利西单抗组中4例治疗（8．3±5．1）个月后出现自身抗体，3例ANA阳性，3例ENA阳性；依那西普组中3例治疗（9．0±3．0）个月后出现自身抗体，3例ANA阳性，1例ENA阳性。结论部分银屑病患者接受抗肿瘤坏死因子d制剂治疗后可出现自身抗体。
Objective To investigate changes in serum levels of antinuclear antibody （ANA）, anti- double-stranded DNA （dsDNA） antibody and anti-extractable nuclear antigen （ENA） antibody before and after anti-tumor necrosis factor-α （TNF-α ）therapy in psoriatic patients. Methods Clinical data obtained from 32 patients with psoriasis were analyzed retrospectively. Of the 32 patients, 13 received intravenous injection of 5 mg/Kg infliximab at week 0, 2, 6 for 3 sessions, then once every 8 weeks （infliximab group）, while other 19 received subcutaneous injection of 25 mg etanercept twice every week （etanercept group）. The treatments in the 2 groups both lasted more than 3 months. Serum levels of ANA, anti-dsDNA antibody and anti-ENA antibody and changes of clinical symptoms were detected and observed respectively before each treatment in the infliximab group, as well as every 3- 6 months in the etanercept group. The 75% reduction in psoriasis area and severity index （PASI75） and disease activity score of 28 joints （DAS28） were used to evaluate clinical efficacy. Serum levels of ANA, anti-dsDNA antibody and anti-ENA antibody were measured by indirect immunofluorescence （IIF） assay, Western blot analysis combined with enzymelinked immunosorbent assay （ELISA）, and Western blot analysis, respectively. Results After 3-month treatment, the 32 patients achieved clinical remission to different extents. Of 32 patients receiving anti-TNF-α therapy, 7 （21.9%） developed new autoantibodies. Concretely speaking, 4 patients in the infliximab group developed antoantibodies in 8.3 ± 5.1 months, including 3 cases positive for ANA and 3 for anti-ENA antibody. Three patients in the etanercept group developed autoantibodies in 9.0 ± 3.0 months, including 3 cases positive for ANA and 1 for anti- ENA antibody. Conclusion Partial patients with psoriasis may develop autoantibodies after anti-TNF-α therapy.
出处
《中华皮肤科杂志》
CAS
CSCD
北大核心
2017年第1期53-56,共4页
Chinese Journal of Dermatology
基金
广东省医学科研基金（A2016259）
广东省中医药常规科研项目（20162021）
