Cluster Analysis of Autoantibodies in 852 Patients with Systemic Lupus Erythematosus from a Single Center
Cluster Analysis of Autoantibodies in 852 Patients with Systemic Lupus Erythematosus from a Single Center
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DOI：
10.3899/jrheum.130984
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发表时间：
2014-07-01
影响因子：
3.9
通讯作者：
Inanc, Murat
中科院分区：
文献类型：
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作者：
Artim-Esen, Bahar;Cene, Erhan;Inanc, Murat
Objective.系统性红斑狼疮（SLE）自身抗体与临床特征之间的相关性已被描述。在此，我们的目的是定义自身抗体簇及其在一个大的SLE患者队列中的临床相关性。我们分析了852例SLE患者谁参加了我们的诊所。选择抗DNA、抗Sm、抗RNP、抗心磷脂（AT）免疫球蛋白（IG）G或IgNt狼疮抗凝剂（LAC）、抗Ro和抗La 7种自身抗体进行聚类分析。采用两步聚类和Kaplan-Meier生存分析。确定了五个集群。一个簇由仅具有抗dsDNA抗体的患者组成，一个簇由抗Sm和抗RNP组成，一个簇由aCL IgG/M和LAC组成，以及一个簇由抗Ro和抗La抗体组成。分析揭示了另外1个聚类，其由不属于由选择用于聚类分析的抗体形成的任何聚类的患者组成。Sm/RNP聚集组肺动脉高压和雷诺现象的发生率明显增高。双链DNA簇在肾损害中的发生率最高。在ACL/LAC组中，有更多的患者患有神经精神疾病、抗磷脂综合征、自身免疫性溶血性贫血和血小板减少症。根据系统性狼疮国际合作诊所损害指数，损害频率最高的是在ACL/LAC集群中。10年和20年生存率比较显示AcL/LAC组生存率降低。本研究支持SLE中存在具有独特临床特征的自身抗体簇，并表明根据自身抗体簇形成临床亚群可能有助于预测疾病的结局。SLE中的自身抗体簇可能根据临床环境或人群表现出差异。
Objective. Associations between autoantibodies and clinical features have been described in systemic lupus erythematosus (SLE). Herein, we aimed to define autoantibody clusters and their clinical correlations in a large cohort of patients with SLE.Methods. We analyzed 852 patients with,SLE who attended our clinic. Seven autoantibodies were selected for cluster analysis: anti-DNA, anti-Sm, anti-RNP, anticardiolipin (AT) immunoglobulin (Ig)G or IgNt lupus anticoagulant (LAC), anti-Ro, and anti-La. Two-step clustering and Kaplan-Meier survival analyses were used.Results. Five clusters were identified. A cluster consisted of patients with only anti-dsDNA antibodies, a cluster of anti-Sm and anti-RNP, a cluster of aCL IgG/M and LAC, and a cluster of anti-Ro and anti-La antibodies. Analysis revealed 1 more cluster that consisted of patients who did not belong to any of the clusters formed by antibodies chosen for cluster analysis. Sm/RNP cluster had significantly higher incidence of pulmonary hypertension and Raynaud phenomenon. DsDNA cluster had the highest incidence of renal involvement. In the aCL/LAC cluster, there were significantly more patients with neuropsychiatric involvement, antiphospholipid syndrome, autoimmune hemolytic anemia, and thrombocytopenia. According to the Systemic Lupus International Collaborating Clinics damage index, the highest frequency of damage was in the aCL/LAC cluster. Comparison of 10 and 20 years survival showed reduced survival in the AcL/LAC cluster.Conclusion. This study supports the existence of autoantibody clusters with distinct clinical features in SLE and shows that forming clinical subsets according to autoantibody clusters may he useful in predicting the outcome of the disease. Autoantibody clusters in SLE may exhibit differences according to the clinical setting or population.