严鸣光　方晓　郭建军

[摘 要] 目的：分析抗α-胞衬蛋白（α-Fodrin）抗体对原发性干燥综合征（Primary Sj?gren syndrom，pSS）的诊断价值。方法：选取我院2012年9月—2015年9月收治的89例pSS患者，并选取同期45例继发性干燥综合征（Secondary SS，sSS）患者、91例系统性红斑狼疮（Systemic lupus erythematosus，SLE）患者、154例类风湿性关节炎（Rheumatoid arthritis，RA）患者及100例健康体检者，使用酶联免疫吸附（ELISA）法对其血清抗α-Fodrin IgA、IgG抗体进行定量检测，均以检测结果>15 U/mL为阳性标准，比较各组受试者血清α-Fodrin IgA、IgG抗体阳性率，并计算抗α-Fodrin抗体对pSS诊断的灵敏度、特异性，分析其诊断价值。结果：pSS组抗α-Fodrin IgA、IgG抗体阳性率均显著高于其他各组，sSS组抗α-Fodrin IgA、IgG抗体阳性率均显著高于SLE组、RA组及对照组，差异有统计学意义（P<0.05）；抗α-Fodrin IgA抗体诊断pSS的灵敏度、特异性分别为65.17%、94.62%，抗α-Fodrin IgG抗体诊断pSS的灵敏度、特异性分别为64.38%、96.67%。结论：抗α-Fodrin抗体诊断pSS有着较高的特异性，但灵敏度有限，故抗α-Fodrin抗体阳性仅可用于pSS的临床辅助诊断，但抗α-Fodrin抗体阴性患者仍不能除外pSS，需以病理检查明确诊断。

[关键词] 抗α-胞衬蛋白抗体；原发性干燥综合征；诊断

中图分类号：R392 文献标识码：B 文章编号：2095-5200（2016）05-084-03

[Abstract] Objective： To analyze the diagnostic value of anti-alpha-fodrin （α-fodrin） antibodies in primary Sj?grens syndrome （pSS）. Methods： 89 cases of pSS patients in our hospital from September 2012 to September 2015 were selected， and 45 cases of secondary Sjogren syndrome （secondary SS， sSS）， 91 cases of patients with systemic lupus erythematosus （SLE）， 154 cases of patients with rheumatoid arthritis （RA） and 100 healthy subjects during the same period were also included. Using enzyme-linked immunosorbent assay （ELISA） on the quantitative detection of serum anti-alpha-fodrin IgG and IgA antibodies， with the detection result of >15 U/mL as positive standard， compare the positive rate of serum anti-alpha-fodrin IgG and IgA antibodies in each group of subjects， and calculate and analyze the sensitivity and specificity of anti-alpha-fodrin antibodies on the diagnosis of pSS. Results： Positive rates of anti-alpha-fodrin IgG and IgA antibodies in pSS group were significantly higher than those in the other groups. Positive rates of anti-alpha-fodrin IgG and IgA antibodies in sSS group were significantly higher than those in SLE group， RA group and control group， the differences were statistically significant （P<0.05）； sensitivity and specificity of anti-alpha-fodrin IgA antibodies in the diagnosis of pSS were 65.17% and 94.62%， and sensitivity and specificity of anti-alpha-fodrin IgG antibodies in the diagnosis of pSS were 64.38% and 96.67%， respectively. Conclusions： anti-alpha-fodrin antibodies in the diagnosis of pSS with high specificity， but the sensitivity is limited， so anti-alpha-fodrin antibodies which were positive can only used for clinical assistant diagnosis of pSS， but the anti-alpha-fodrin antibodies negative patients still cannot be excluded with pSS， which should be pathologically examined for clear diagnosis.

[Key words] anti-alpha cytoplasmic antibody； primary dry syndrome； diagnosis

干燥综合征（Sj?gren syndrom，SS）是常见的自身免疫系统紊乱性疾病，发病率约为0.5%～5.0%，其临床特点以泪腺、唾液腺淋巴细胞浸润并引发角膜结膜炎及口腔干燥为主[1]。其中，原发性干燥综合征（Primary SS，pSS）由遗传、病毒感染和性激素异常等多种因素引发，是SS最常见的类型，且常伴有肺、肝、肾、血液系统和神经系统受累，严重时可威胁患者生存质量[2]。抗SSA抗体、抗SSB抗体是诊断pSS的常用指标，但抗SSA抗体在系统性红斑狼疮（Systemic lupus erythematosus，SLE）等其他自身免疫性疾病中亦有着较高的阳性率，且抗SSB抗体敏感度较低，同时，唇腺活检和腮腺造影为有创检查且费用较高，临床推广受限，因此，目前临床pSS的漏诊率及误诊率仍处于较高水平[3-4]。故寻求一种敏感度、特异性高的血清学指标是早期明确pSS诊断的关键。我们选取抗α-胞衬蛋白（α-Fodrin）抗体，以我院2012年9月—2015年9月收治的479例受试者为研究对象进行了前瞻性研究。