背景:抗SS-A/Ro抗体(抗SSA),干燥综合征(SS)的诊断标志物,通常在系统性硬化症(SSc)中检测到。一些患者被诊断为SSc/SS重叠综合征,而无SS的抗SSA阳性SSc病例。在这项研究中,我们研究了SSc与抗SSA的临床特征,并阐明了该抗体在SSc中的临床影响。
方法:对2018年至2021年横滨市立大学医院156例SSc患者进行回顾性分析。临床数据,实验室数据,成像,收集和分析自身抗体阳性状态,以使用多变量逻辑回归分析评估这些变量与抗SSA之间的关联.
结果:该队列包括18名男性和138名女性SSc(中位年龄,69.0年)。39例患者有弥漫性皮肤SSc(dcSSc)(25%),117例患者皮肤SSc受限(75%)。44例患者为抗SSA阳性。其中,24符合SS标准。多变量逻辑回归显示抗SSA与间质性肺病有统计学关联(ILD;比值比[OR]=2.67;95%置信区间[CI],1.14-6.3;P=0.024)。同时,抗SSA阳性倾向于增加手指溃疡的发展(OR=2.18;95%CI,0.99-4.82,P=0.054)。在自身抗体单阳性和抗SSA/SSc特异性自身抗体双阳性组的比较分析中,抗SSA单阳性组ILD风险显著增加(OR=12.1;95%CI,2.13-140.57;P=0.003).此外,SSc和抗SSA患者表明,与SS患者相比,无SS的抗SSA阳性SSc与dcSSc密切相关(OR=6.45;95%CI,1.23-32.60;P=0.024)。
结论:抗SSA阳性增加器官受累的风险,例如ILD,在SSc患者中。此外,无SS的抗SSA阳性SSc人群的皮肤纤维化可能比其他人群更严重.抗SSA可能是SSc中ILD和皮肤严重程度的潜在标志物。
BACKGROUND: Anti-SS-A/Ro antibody (anti-SSA), the diagnostic marker of Sjögren\'s syndrome (SS), is often detected in systemic sclerosis (SSc). Some patients are diagnosed with SSc/SS overlap syndromes, while there are anti-SSA-positive SSc cases without SS. In this study, we investigated the clinical characteristics of SSc with anti-SSA and clarified the clinical impact of this antibody in SSc.
METHODS: A retrospective chart review was conducted of 156 patients with SSc at Yokohama City University Hospital from 2018 to 2021. Clinical data, laboratory data, imaging, and autoantibody positivity status were collected and analysed to assess the association between these variables and anti-SSA using multivariable logistic regression analysis.
RESULTS: This cohort included 18 men and 138 women with SSc (median age, 69.0 years). Thirty-nine patients had diffuse cutaneous SSc (dcSSc) (25%), and 117 patients had limited cutaneous SSc (75%). Forty-four patients were anti-SSA-positive. Among them, 24 fulfilled the SS criteria. Multivariable logistic regression revealed that anti-SSA was statistically associated with interstitial lung disease (ILD; odds ratio [OR] = 2.67; 95% confidence interval [CI], 1.14-6.3; P = 0.024). Meanwhile, anti-SSA positivity tended to increase the development of digital ulcer (OR = 2.18; 95% CI, 0.99-4.82, P = 0.054). In the comparative analysis of the autoantibody single-positive and anti-SSA/SSc-specific autoantibody double-positive groups, the anti-SSA single-positive group showed a significantly increased risk of ILD (OR = 12.1; 95% CI, 2.13-140.57; P = 0.003). Furthermore, patients with SSc and anti-SSA indicated that anti-SSA-positive SSc without SS was strongly associated with dcSSc when compared to that in patients with SS (OR = 6.45; 95% CI, 1.23-32.60; P = 0.024).
CONCLUSIONS: Anti-SSA positivity increases the risk of organ involvement, such as ILD, in patients with SSc. Additionally, the anti-SSA-positive SSc without SS population may have more severe skin fibrosis than others. Anti-SSA may be a potential marker of ILD and skin severity in SSc.