中华皮肤科杂志 ›› 2017, Vol. 50 ›› Issue (1): 53-56.

• 研究报道 • 上一篇    下一篇

银屑病患者抗肿瘤坏死因子α治疗前后血清抗核抗体、抗dsDNA抗体及抗ENA抗体的变化

吉苏云1,陈永锋1,宫晓2,谷梅1,王宇1,袁立燕3,杨斌1   

  1. 1. 广东省皮肤病医院
    2. 广东药科大学公共卫生学院
    3. 广东省皮肤性病防治中心
  • 收稿日期:2016-01-19 修回日期:2016-08-20 出版日期:2017-01-15 发布日期:2017-01-05
  • 通讯作者: 杨斌 E-mail:binyanggz@hotmail.com

Changes in serum levels of antinuclear antibody, anti?double?stranded DNA antibody and anti?extractable nuclear antigens antibody before and after anti?tumor necrosis factor?α therapy in psoriatic patients

  • Received:2016-01-19 Revised:2016-08-20 Online:2017-01-15 Published:2017-01-05

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摘要： 目的 观察银屑病患者接受抗肿瘤坏死因子α制剂治疗后抗核抗体（ANA）、抗dsDNA抗体和抗可提取性核抗原（ENA）抗体的变化。方法 回顾分析32 例银屑病患者，其中13例使用英夫利西单抗治疗，19例使用依那西普治疗。英夫利西单抗组第0、2、6 周各用药1 次，此后每隔8 周用药，于每次用药前检测患者ANA、抗dsDNA 抗体及ENA的情况和临床症状的变化。依那西普组每周用药2次，每3 ~ 6 个月检测患者ANA、抗dsDNA 抗体及ENA的情况和临床症状的变化。采用银屑病皮损面积和严重度指数（PASI）75、疾病活动评分（DAS）28评估临床疗效，间接免疫荧光法检测血清ANA水平，免疫印迹法和ELISA 法检测抗dsDNA 抗体水平，免疫印迹法检测抗ENA抗体水平。结果 32 例银屑病患者临床症状有不同程度缓解。32例抗TNF?α治疗的患者中有7例（21.9%）出现自身抗体，其中英夫利西单抗组中4 例治疗（8.3 ± 5.1）个月后出现自身抗体，3例ANA阳性，3例ENA阳性；依那西普组中3 例治疗（9.0 ± 3.0）个月后出现自身抗体，3例ANA阳性，1例ENA阳性。结论 部分银屑病患者接受抗肿瘤坏死因子α制剂治疗后可出现自身抗体。

Abstract: Ji Suyun, Chen Yongfeng, Gong Xiao, Gu Mei, Wang Yu, Yuan Liyan, Yang Bin Department of Dermatology, Guangdong Provincial Dermatology Hospital, Guangzhou 510091, China （Ji SY, Chen YF, Gu M, Wang Y, Yuan LY, Yang B）; School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510006, China （Gong X） Corresponding author: Yang Bin, Email: binyang101@163.com 【Abstract】 Objective To investigate changes in serum levels of antinuclear antibody （ANA）, anti-double-stranded DNA （dsDNA） antibody and anti-extractable nuclear antigen （ENA） antibody before and after anti-tumor necrosis factor-α （TNF-α） therapy in psoriatic patients. Methods Clinical data obtained from 32 patients with psoriasis were analyzed retrospectively. Of the 32 patients, 13 received intravenous injection of 5 mg/Kg infliximab at week 0, 2, 6 for 3 sessions, then once every 8 weeks （infliximab group）, while other 19 received subcutaneous injection of 25 mg etanercept twice every week （etanercept group）. The treatments in the 2 groups both lasted more than 3 months. Serum levels of ANA, anti-dsDNA antibody and anti-ENA antibody and changes of clinical symptoms were detected and observed respectively before each treatment in the infliximab group, as well as every 3 - 6 months in the etanercept group. The 75% reduction in psoriasis area and severity index （PASI75） and disease activity score of 28 joints （DAS28） were used to evaluate clinical efficacy. Serum levels of ANA, anti-dsDNA antibody and anti-ENA antibody were measured by indirect immunofluorescence （IIF） assay, Western blot analysis combined with enzyme-linked immunosorbent assay （ELISA）, and Western blot analysis, respectively. Results After 3-month treatment, the 32 patients achieved clinical remission to different extents. Of 32 patients receiving anti-TNF-α therapy, 7 （21.9%） developed new autoantibodies. Concretely speaking, 4 patients in the infliximab group developed autoantibodies in 8.3 ± 5.1 months, including 3 cases positive for ANA and 3 for anti-ENA antibody. Three patients in the etanercept group developed autoantibodies in 9.0 ± 3.0 months, including 3 cases positive for ANA and 1 for anti-ENA antibody. Conclusion Partial patients with psoriasis may develop autoantibodies after anti-TNF-α therapy.