文献简介

出版社:国际皮肤性病学杂志

作  者:许丛丛;王培光

编  号:

关键字:皮肌炎;自身抗体;抗MDA5抗体;抗TIF-1γ抗体;抗NXP-2抗体;抗EJ抗体;抗Mi-2抗体;抗Jo-1抗体

年  份:2017   点击量:97

文献摘要

【摘要】一些自身抗体包括抗黑素瘤分化相关基因5抗体、抗转录中介因子1γ抗体、抗核基质蛋白2抗体、抗甘氨酰-tRNA合成酶抗体、抗核小体重塑和组蛋白脱乙酰酶蛋白复合物抗体、抗组氨酰-tRNA合成酶抗体等与皮肌炎的临床表型和预后密切相关。抗黑素瘤分化相关基因5抗体、抗甘氨酰-tRNA合成酶抗体、抗组氨酰-tRNA合成酶抗体与皮肌炎并发间质性肺病有关,特别是抗黑素瘤分化相关基因5抗体与皮肌炎并发的间质性肺病的发生、病情活动和患者高死亡率显著相关。通常抗黑素瘤分化相关基因5抗体阳性的患者对常规的免疫抑制治疗疗效欠佳。抗转录中介因子1γ抗体、抗核基质蛋白2抗体与恶性肿瘤相关性皮肌炎有关。此外抗转录中介因子1γ抗体和抗核基质蛋白2抗体还与皮肌炎其他一些特征性临床表型相关,如抗转录中介因子1γ抗体阳性的患者发生银屑病样损害、手掌角化过度性丘疹明显增加,而抗核基质蛋白2抗体阳性的患者发生前臂、小腿和颈部无力更为常见。抗核小体重塑和组蛋白脱乙酰酶蛋白复合物抗体阳性患者发生间质性肺病风险和维持过长时间治疗的风险明显降低。因此临床上广泛地开展这些自身抗体的检测有助于指导皮肌炎的临床诊疗。

Abstractsome autoantibodies have been identified to be closely associated with the clinical phenotypes and prognosis of dermatomyositis, such as anti-melanoma differentiation-associated gene 5 (MDA5)antibody, anti-transcriptional intermediary factor 1-γ(TIF-1γ)antibody, anti-nuclear matrix protein-2(NXP-2)antibody, anti-glycyl-tRNA synthetase(anti-EJ)antibody, anti-nucleosome remodeling and histone deacetylase complex(anti-Mi-2)antibody, anti-histidyl-tRNA synthetase(anti-Jo-1) antibody, and so on. Anti-MDA5, anti-EJ and anti-Jo-1 antibodies are all related to dermatomyositis complicated by interstitial lung disease,  especially anti-MDA5 antibody, which is significantly associated with the occurrence, disease activity and high mortality of dermatomyositis complicated by interstitial lung disease. Usually, anti-MDA5 antibody-positive patients have poor response to conventional immunosuppressive treatments. Anti-TIF-1γand anti-NXP-2 antibodies are related to cancer-associated dermatomyositis. Moreover, anti-TIF-1γ and anti-NXP-2 antibodies are linked to some other distinctive clinical phenotypes of dermatomyositis. For example, obviously increased occurrence of psoriasis-like lesions and hyperkeratotic papules of palms is observed in anti-TIF-1γantibody-positive patients, while muscle weakness in the forearms, lower legs and neck occurs more commonly in anti-NXP-2 antibody-positive patients. However, anti-Mi-2 antibody-positive patients have significantly decreased risk of interstitial lung disease and prolonged duration of treatment. Thus, wide application of the detection of these autoantibodies will be helpful to guide the diagnosis and treatment of dermatomyositis.