HLA-B27抗原检测对眼部炎症合并强直性脊柱炎的诊断意义
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摘要
目的探讨HLA-B27抗原检测对眼部炎症患者合并强直性脊柱炎(AS)的诊断意义。方法连续收集2012年1月至2015年10月北京同仁医院初发非感染性眼部炎症患者776例,依据发病部位将患者分为葡萄膜炎、巩膜炎、角膜炎和结膜炎四组。检测患者外周血淋巴细胞HLA-B27抗原表达,结合临床资料明确患者是否合并AS。结果 776例患者中149例确诊合并AS,其中葡萄膜炎组130例,巩膜炎组6例,角膜炎组6例,结膜炎组7例。葡萄膜炎组患者的HLA-B27阳性率为25.80%,明显高于巩膜炎组的4.27%、角膜炎组的6.45%和结膜炎组的12.12%,差异均有统计学意义(P<0.05);HLA-B27抗原检测对眼部炎症患者合并AS诊断的灵敏度为94.63%,特异度为98.67%,阳性预测值为95.27%,阴性预测值为98.48%,正确指数为0.93。结论合并AS的眼部炎症患者主要表现为葡萄膜炎,也可表现为结膜炎、角膜炎和巩膜炎等。临床上对初发非感染性眼部炎症患者进行HLA-B27抗原检测,可以辅助诊断其是否合并AS。
Objective To investigate the value of human leukocyte antigen B27(HLA-B27) detection in diagnosis of ophthalmitis complicated with ankylosing spondylitis(AS). Methods A total of 776 patients newly diagnosed as non-infective ophthalmitis from January 2012 to October 2015 in Beijing Tongren Hospital were collected. The patients were divided into uveitis group, scleritis group, iritis group and conjunctivitis group according to pathogenic sites.They were tested for HLA-B27 expression in peripheral blood lymphocytes in order to identify the combination of AS based on clinical data. Results Among the 776 patients, 149 were diagnosed with AS, including 130 patients in uveitis group, 6 patients in scleritis group, 6 patients in iritis group and 7 patients in conjunctivitis group. HLA-B27 positive rate were 25.80% in uveitis group, which was significantly higher than 4.27% in scleritis group, 6.45% in iritis group and12.12% in conjunctivitis group, with statistically significant differences(P<0.05). When HLA-B27 detection was used to diagnose ophthalmitis with AS, the sensitivity, specificity, positive predictive value, negative predictive value and correct index were 94.63%, 98.67%, 95.27%, 98.48%, 0.93. Conclusion Ophthalmitis complicated with AS is primarily manifested as uveitis, but also as conjunctivitis, iritis and scleritis. HLA-B27 detections could be helpful in the auxiliary diagnosis of ophthalmitis complicated with AS.
Objective To investigate the value of human leukocyte antigen B27(HLA-B27) detection in diagnosis of ophthalmitis complicated with ankylosing spondylitis(AS). Methods A total of 776 patients newly diagnosed as non-infective ophthalmitis from January 2012 to October 2015 in Beijing Tongren Hospital were collected. The patients were divided into uveitis group, scleritis group, iritis group and conjunctivitis group according to pathogenic sites.They were tested for HLA-B27 expression in peripheral blood lymphocytes in order to identify the combination of AS based on clinical data. Results Among the 776 patients, 149 were diagnosed with AS, including 130 patients in uveitis group, 6 patients in scleritis group, 6 patients in iritis group and 7 patients in conjunctivitis group. HLA-B27 positive rate were 25.80% in uveitis group, which was significantly higher than 4.27% in scleritis group, 6.45% in iritis group and12.12% in conjunctivitis group, with statistically significant differences(P<0.05). When HLA-B27 detection was used to diagnose ophthalmitis with AS, the sensitivity, specificity, positive predictive value, negative predictive value and correct index were 94.63%, 98.67%, 95.27%, 98.48%, 0.93. Conclusion Ophthalmitis complicated with AS is primarily manifested as uveitis, but also as conjunctivitis, iritis and scleritis. HLA-B27 detections could be helpful in the auxiliary diagnosis of ophthalmitis complicated with AS.
引文
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[15]Li H,Li Q,Ji C,et al.Ankylosing Spondylitis Patients with HLA-B2704 have More Uveitis than Patients with HLA-B 2705 in a North Chinese Popu Lation[J].Ocu L Immunol Inflamm,2016,18:1-5.
[16]Rostoms S,Dougados M,Gossec L,et al.New tools for diagnosing spondyloarthropathy[J].Joint Bone Spine,2010,77(2):108-114.
[17]李坤鹏,黄烽.强直性脊柱炎:一种被忽视的全身性疾病[J].中华内科杂志,2015,54(11):913-915.
[18]蔡颜嵘,徐卫东.基于强直性脊柱炎骨化相关信号通路探讨其炎症与骨化的关系[J].中华风湿病学杂志,2015,19(6):428-431.
[2]刘蕊,刘湘源,赵金霞,等.伴前葡萄炎的脊柱关节病86例临床分析[J].中华风湿病学杂志,2010,14(11):762-765.
[3]杨双双,张莉萍.人类白细胞抗原B27相关性葡萄膜炎与性别及年龄的关系[J].检验医学与临床,2011,8(16):1929-1930.
[4]宋国祥,黄进贤,邓亚玲,等.强直性脊柱炎伴发葡萄膜炎82例临床分析[J].海南医学,2014,25(20):3059-3061.
[5]陈丽华,伍雪芬,许福荣,等.强直性脊柱炎伴发葡萄膜炎18例临床分析[J].国际眼科杂志,2014,14(1):160-161.
[6]马翠萍,骆荣江,陈雪梅,等.强直性脊椎炎伴发葡萄膜炎的临床特征及漏诊误诊分析[J].中国临床实用医学,2010,4(3):85-86.
[7]Arshee SA,Jyotirmay B.Uveitis:a search for a cause[J].Taiwan J Ophthalmol,2013,3(4):134-40.
[8]Yabuki K,Inoko H,Ohno S.HLA testing in patients with uveitis[J].Int Ophthalmol Clin,2000,40(2):19-35.
[9]Loh AR,Acharya NR.Incidence rates and risk factors for ocu Lar complications and vision loss in HLA-B27-associated uveitis[J].Am J Ophthalmol,2010,150(4):534-542.
[10]陈振超,任庆芬,谭茂卿.葡萄膜炎中人类白细胞抗原B27阳性表达与临床关系分析[J].实用医技杂志,2015,22(1):62-63.
[11]李梦远,姚中强,刘湘.HLA-B27与强直性脊柱炎免疫学机制的研究进展[J].生理科学进展,2011,42(1):28-38.
[12]Chen SC,Chuang CT,Chu MY,et al.Patterns and Etiologies of Uveitis at a Tertiary Referral Center in Taiwan[J].Ocu L Immunol Inflamm.2016,27:1-8.
[13]刘永杰,张小芳,张运刚,等.HLA-B27检测对强制性脊柱炎诊断的临床意义[J].国际检验医学杂志,2014,35(10):1285-1286.
[14]Colbert RA,Delay ML,Klenk EI,et al.From HLA-B27 to spondy loarthritis:a journey through the ER[J].Immunol Rev,2010,233(1):181-202.
[15]Li H,Li Q,Ji C,et al.Ankylosing Spondylitis Patients with HLA-B2704 have More Uveitis than Patients with HLA-B 2705 in a North Chinese Popu Lation[J].Ocu L Immunol Inflamm,2016,18:1-5.
[16]Rostoms S,Dougados M,Gossec L,et al.New tools for diagnosing spondyloarthropathy[J].Joint Bone Spine,2010,77(2):108-114.
[17]李坤鹏,黄烽.强直性脊柱炎:一种被忽视的全身性疾病[J].中华内科杂志,2015,54(11):913-915.
[18]蔡颜嵘,徐卫东.基于强直性脊柱炎骨化相关信号通路探讨其炎症与骨化的关系[J].中华风湿病学杂志,2015,19(6):428-431.