各種風濕疾病病人血清中抗核抗體之臨床價值

Clinical Significance of Antinuclear Antibodies in Rheumatic Disorders

將205例各種風濕性疾病患者血清使用免疫螢光法檢驗抗核抗體(FANA)；另使用相交電泳法檢驗(CIE)抗nDNA，抗ENA抗RNP與抗Sm抗體。吾等發現各種疾病出現此類自體抗體之機會不一。FANA最為敏感，吾等所驗之60例SLE皆陽性， speckled型最常見、濃度亦高。CIE操作簡單、而且甚為可靠、抗nDNA在SLE病人敏感度高達63.3％，但此抗體也可常出現於SLE外，尚可在類風濕性關節炎或硬皮症病人、抗Sm抗體僅在SLE病人出現，其敏感度高達至48.3％。同時測驗FANA抗nDNA及抗Sm對這些風濕性疾病之鑑別診斷甚為有用。雖然如此，自體抗體不易與疾病臨床表現連繫。

Serum samples irom 205 patients with rheumatic disorders were surveyed for anti-natural DNA (nDNA), antiextractable nuclear antigen (ENA), anti-ribonucleoprotein (RNP), and anti-Smith (Sm) antigen by counter immunoelectrophoresis (CIE), and for nluorescent anti-nuclear anti-body (FANA) by indirect immune of uorescent technique. Anti-nDNA was detected in 66.3% of patients with systemic lupus erythematosus (SLE) as well as other related diseases. Anti-ENA and anti-RNP were detected in SLE, rheumatoid arthritis (RA) and progressive systemic sclerosis (PSS). Anti-Sm is specific for SLE, and it was detected in 48.3% of the SLE patients. FANA is highly sensitive and it was positive in all 60 SLE patients and many of them showed speckled pattern in high titers. Positive CIE-detected autoantibodies correlated to speckled FANA pattern in high titers. The sensitivities and specificities of the autoantibodies vary greatly and combined defections of anti-nDNA, anti-Sm and FANA can provide useful criteria for differential diagnosis among rheumatic disorders. However, no good correlation was made between these autoantibodies and the major clinical manifestations.