抗著絲點抗體會增加乾燥症病人的罹癌風險

Increased cancer incidence in SICCA syndrome patients positive for anti-centromere antibody

目的：了解抗著絲點抗體在乾燥症病人的臨床表現和診斷。方法：在這回顧研究中，收集71位在2006年至2014年間證實罹患乾燥症的病人。分析基本資料、臨床症狀和最後診斷。結果：在71位乾燥病的病人中，有抗著絲點抗體的病人是35位平均年齡是59.26±11.29歲，而沒有著絲點抗體的病人是36位平均年齡是54.36±11.37歲。在臨床表現上，有著絲點抗體的這組，肌肉酸痛的方面和沒有抗體的病人有明差異（p < 0.05）。在抗體的表現上，我們發現有著絲點抗體的乾燥症病人比較不會呈現抗Ro/SS抗體或抗La/SSB抗體。在最後的診斷我們發現乾燥症病人在著絲點抗體陽性下，診斷為癌症的比例明顯高於沒有著絲點抗體的病（odds ratio=10.37; p=0.01）。結論：在臨床表現有乾燥症的病人，如果呈現抗著絲點抗體陽性，需要考慮罹癌的風險。

Objectives: The main purposes of this study were to determine the clinical significance of the presence or absence of the anti-centromere antibody in SICCA Syndrome and to diagnose the symptoms. Methods: We retrospectively investigated the prevalence of ACA in patients with SICCA syndrome between January 2006 and January 2014 in Kaohsiung Chang Gung Memorial Hospital. We compared ACA-positive patients with ACA-negative patients. Results: Clinical manifestations in ACA-positive patients are shown in table 2. Many of the clinical symptoms were primarily associated with the predominant disease, scleroderma, limited scleroderma, systemic lupus erythematosus or Sjögren’s syndrome (SS). Myalgia was the most prevalent manifestation among those that were ACA-positive. There were fewer ACA-positive SICCA patients with anti-SSA or anti-SSB antibodies than ACA-negative SICCA patients (p <0.01, p = 0.011, respectively). Among 35 ACA-positive patients, SS was found in 21 patients (60.0 %), including 13 with primary SS and 8 with secondary SS. In the other 14 patients, 8 had cancer and 6 had other diseases. Among 36 ACA-negative patients, SS was found in 33 patients (91.6 %), including 29 with primary SS and 4 with secondary SS. In the other three patients, one had cancer and two had thyroid diseases. The incidence of cancer was significantly higher in the ACA-positive group than in the ACA-negative group [odds ratio = 10.37; 95 % confidence interval (CI), 1.22–88.02; p < 0.05]. Conclusion: In our study, ACA-positive patients with SICCA syndrome had increased incidence of cancer (p < 0.01; odds ratio = 10.37) and lower prevalence of anti-SSA/anti-SSB antibodies. With regard to cancer risk, anti-centromere positive SICCA syndrome patients should be carefully evaluated for early diagnosis of cancer.