译者:高文琴 校对:庞宇洁 审核:张莉芸
Abstract:-IVE:This study evaluates possible correlations between the pattern of antinuclear antibodies (ANA) on indirect immunofluorescence (IIF) testing and nailfold microangiopathy stage (early, active, and late stage) in systemic sclerosis (SSc). Patients with SSc were followed prospectively to monitor progression of microvascular damage.METHODS:The ANA pattern on IIF was searched in 42 patients with SSc showing an early pattern of nailfold microangiopathy at -line, and was followed using nailfold videocapillaroscopy (NVC) for a median time of 91 months.RESULTS:Among patients whose microangiopathy showed a rapid progression from early to late pattern on NVC, the IIF pattern was fine-speckled + nucleolar (Scl-70+) in 44%, centromeric in 33%, nucleolar in 11%, and homogeneous in 11% of patients with SSc. Antitopoisomerase I antibodies were significantly more frequent (57%) in patients with late pattern of microangiopathy on NVC. The median time of progression from early to active disease was significantly lower in patients with both fine-speckled + nucleolar and nucleolar ANA positivity. The severity of microangiopathy was higher in patients with the nucleolar pattern on IIF. Patients already showing a slight reduction of capillary number at -line were likely to have either the nucleolar or the fine-speckled + nucleolar pattern on IIF. Of note, 37% of patients still showing the early microangiopathy pattern on NVC at the end of the followup were ANA-negative.CONCLUSION:ANA-negative patients with SSc display a slower progression of nailfold microangiopathy characterized by the early pattern on NVC. Progression to the late NVC pattern (more advanced stage of microvascular damage) seems to be associated with a different autoantibody pattern on IIF (fine-speckled + nucleolar pattern being the most prevalent).
摘要:目的:本研究旨在探讨系统性硬化病(SSc))抗核抗体(ANA)(间接免疫荧光法检测)和甲襞微血管病变程度(早期,活动期,晚期)之间可能的相关性。本研究是一项随访SSc患者微血管损伤进展的前瞻性研究。方法:选取42名基线甲襞微血管病变为早期改变的SSc患者,间接免疫荧光法检测ANA核型,甲襞微循环检查(NVC)随访91个月。结果:甲襞微血管病变由早期快速进展到晚期的患者中,间接免疫荧光结果:44%为斑点型+核仁型(SCL-70+),33%为着丝点型,11%为核仁型,11%均质型。抗拓扑异构酶Ⅰ抗体更多见于甲襞微循环晚期改变的患者(57%)。ANA斑点型+核仁型和核仁型的患者甲襞微循环由早期进展到活动期的时间显著缩短。ANA核仁型患者微血管病变的程度更重。基线水平已经有轻微毛细血管数减少的患者,间接免疫荧光结果可能为核仁型或斑点型+核仁型。值得注意的是,在随访结束时有37%的患者甲襞微循环一直表现为早期改变,这部分患者ANA为阴性。结论:ANA阴性、甲襞微循环为早期改变的SSc患者甲襞微血管病变进展较为缓慢。发展到甲襞微循环晚期改变(微血管损伤晚期阶段)的患者,似乎与不同的ANA核型相关(斑点型+核仁型最为普遍)。
引自:Sulli A1, Ruaro B, Smith V, et al.Progression of nailfold microvascular damage and antinuclear antibody pattern in systemic sclerosis.J Rheumatol. 2013 May;40(5):634-639.