전신성 류마티스 질환에서 항 ENA 항체에 관한 연구 = The Detection of Anti-ENA Antibodies in Systemic Rheumatic Diseases

다국어 초록 (Multilingual Abstract)

Objectives: Among a variety of nuclear antigens, extractable nuclear antigens(ENA) which can be extracted from nuclei by homogenization in neutral saline contain ribonucleoprotin, Sm, SS-A/Ro, SS-B/La and other antigens. Characterization of anti-ENA anti-bodies provides information about nosology, subset definition within diseases, clinical activity, specific organ involvement and prognosis. Methods: Authors have used double immunodiffusion test to detect antibodies to ENAs and studied the frequencies of autoantibodies to these antigens and their correlation with clinical and laboratory features in systemic rheumatic diseases. Results: 1) 1,063 patients were investigated for the presence of serum antibodies to ENAs and 180 out of 1,063 patients (16.9%) had anti-ENA antibodies. 3,412 tests were performed for the presence of antibodies to Sm, RNP, Ro, La, Scl-70 and Jo-1 respectively and 230 out of 3,412 tests (6.7%) were positive. 2) The profiles of 137 patients who had anti-ENA antibodies are systemic lupus erythematosus (61), rheumatoid arthritis with secondary Sj6gren's syndrome (26) and without secondary Sjogren's syndrom (9), mixed connective tissue disease (18), scleroderma (10), polymyosits/dermatomyositis (6), undifferentiated connective tissue diease (4), gout (1), fibromyalgia syndrome (1) and Hashimoto's thyroiditis (1). 3) The frequencies of antibodes to ENAs were 73.5% in patiets with systemic lupus erythemtosus, 9.6% in rheumatoid arthritis, 100% in mixed connective tissue disease, 71.4% in scleroderma and 46.2% in polymyostis/dermatomyositis. 4) The frequencies of antibodies to Sm, RNP, Ro and La in patients with systemic lupus erythematosus were 18.1%, 41.5% 43.9% and 4.9% respectively. (1) Patients with anti-Sm antbodies had a higher incidence of pleuritis than those without anti-Sm antibodies(p=0.029). (2) Patients with anti-RNP anibodies had a higher incidence of Raynaud's phenomenon and pleuritis and a lower incidence of renal disease than those without anti-RNP antibodies (p=0.008, p=0.019, p=0.029). (3) Patients with anti-Ro antibodies had a higher incidence of thrombocytopenia than those without anti- Ro antibodies. (4) There were no clinical and laboratory differences between patients with anti-La antibodies and without anti-La antibodies. 5) In patients with rheumatoid arthritis, anti-Ro anti-body was likely to be associated wih secondary Sjogren syndrome, although statistically significant association was not found (p=0.063). Conclusions: These results showed that the detection of antibodies to ENAs by double immunodiffusion test was expected to be a useful diagnostic marker and predict some clinical features in systemic rheumatic diseases.