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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (6): 1000-1006. doi: 10.19723/j.issn.1671-167X.2023.06.007

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Comparison of clinical and immunological characteristics between primary Sjögren's syndrome patients with positive and negative anti-SSB antibody

Yi-jun HAN1,Chang-hong LI1,Xiu-ying CHEN2,Jin-xia ZHAO1,*()   

  1. 1. Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Internal Medicine, Yanqing Hospital, Peking University Third Hospital, Beijing 102100, China
  • Received:2023-08-30 Online:2023-12-18 Published:2023-12-11
  • Contact: Jin-xia ZHAO E-mail:zhao-jinxia@163.com

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Abstract:

Objective: To analyze the differences of clinical manifestations and laboratory features between primary Sjögren’s syndrome (pSS) patients with positive and negative anti-Sjögren’s syndrome type B (SSB) antibody. Methods: The clinical data of pSS patients hospitalized in Department of Rheumato-logy and Immunology, Peking University Third Hospital were retrospectively analyzed to investigate the differences of clinical and laboratory features between anti-SSB positive and negative groups. The t test, Mann-Whitney U test, Chi-square test and Fisher’s exact probability were used for analysis. Results: A total of 142 pSS patients were enrolled in this study, including 137 females and 5 males with a mean age of (54.8±13.3) years. The anti-SSB positive group included 44 patients accounting for 31.0% of the pSS patients. The anti-SSB positive pSS patients were younger at disease onset and at visit [age at visit: (50.9±14.5) years vs. (56.5±12.4) years; age at onset: (42.2±14.8) years vs. (49.5±15.3) years, P < 0.05]. The patients with anti-SSB positive more frequently presented with rash (29.5% vs. 14.3%, P < 0.05), enlargement of parotid glands (27.3% vs. 8.2%, P < 0.05), renal tubular acidosis (15.9% vs. 4.2%, P < 0.05), immune thrombocytopenia (9.1% vs. 1.0%, P < 0.05), rheumatoid factor (RF) positive (85.0% vs. 49.4%, P < 0.05), higher RF and antinuclear antibody (ANA) titers (median: 89.8 IU/mL vs. 20.5 IU/mL; median: 320 vs. 160, P < 0.05), anti-Sjögren’s syndrome type A (SSA) antibody positive (97.7% vs. 64.3%, P < 0.05), elevation of γ globulin (71.4% vs. 38.5%, P < 0.05), higher levels of IgG (median: 21.0 g/L vs. 15.6 g/L, P < 0.05), higher proportions of CD3-CD19+ cells [(21.0±11.9)% vs. (13.7±9.6)%, P < 0.05] and lower proportions of CD3+ cells [(67.2±14.4)% vs. (76.6%±13.1)%, P < 0.05] than those negative. However, the anti-SSB positive group was less likely to show anti-mitochondrial antibodies (AMA)-M2 positivity (10.5% vs. 35.6%, P < 0.05). Glucocorticoids (90.9% vs. 73.5%, P < 0.05) and immunosuppressants (54.5% vs. 36.7%, P < 0.05) were more frequently used in anti-SSB positive pSS patients than those negative. Conclusion: The anti-SSB positive pSS patients were younger at disease onset while more frequently presenting with various symptoms, higher levels of other antibodies and activation of B cells than those negative. Glucocorticoids and immunosuppressants were more frequently used, indicating that anti-SSB positive group presented with a more severe clinal phenotype.

Key words: Primary Sjögren's syndrome, Anti-SSB antibody, Immunological characteristics

CLC Number: 

  • R593.2

Table 1

Comparison of clinical symptoms between pSS patients with positive and negative anti-SSB antibody"

Items Anti-SSB (+), n=44, n (%) Anti-SSB (-), n=98, n (%) χ2 P
Oral dryness 41 (93.2) 88 (89.8) 0.754#
Ocular dryness 30 (68.2) 65 (66.3) 0.047 >0.999
Raynaud phenomenon 5 (11.4) 11 (11.2) >0.999#
Rash 13 (29.5) 14 (14.3) 4.592 0.032*
Enlargement of lymph nodes 15 (34.1) 28 (28.6) 0.438 0.508
Enlargement of parotid glands 12 (27.3) 8 (8.2) 9.164 0.002*
Arthralgia 19 (43.2) 37 (37.8) 0.374 0.541
Rampant dental caries 23 (52.3) 42 (42.9) 1.085 0.298
Fever 12 (27.3) 24 (24.5) 0.124 0.724
Fatigue 20 (45.5) 30 (30.6) 2.932 0.087
Dyspnea 9 (20.5) 19 (19.4) 0.022 0.883
Hashimoto’s thyroiditis 2 (4.5) 5 (5.1) >0.999#
PBC 0 (0) 9 (9.2) 0.057#
Autoimmune hepatitis 1 (2.3) 4 (4.1) >0.999#
RTA 7 (15.9) 4 (4.2) 0.035#*
Hemolytic anemia 1 (2.3) 0 (0) 0.310#
ITP 4 (9.1) 1 (1.0) 0.032#*
Neurologic abnormalities 9 (20.5) 16 (16.3) 0.357 0.550
Dysfunction of esophagus 2 (4.5) 7 (7.1) 0.721#
Atrophic gastritis 0 (0) 8 (8.2) 0.058#
ILD 5 (11.4) 22 (22.4) 2.423 0.120
Pleural effusion 1 (2.3) 2 (2.0) >0.999#
PAH 3 (6.8) 7 (7.1) >0.999#
Positive lip biopsy 9/11 (81.8) 45/52 (86.5) 0.650#

Table 2

Comparison of laboratory features between pSS patients with positive and negative anti-SSB antibody"

Items Anti-SSB (+), n=44 Anti-SSB (-), n=98 t/Z χ2 P
WBC/(×109/L) 5.47±3.18 5.82±2.55 0.699 0.486
RBC/(×1012/L) 3.92±0.59 3.95±0.63 0.324 0.746
HB/(g/L) 117.86±16.99 119.40±18.06 0.477 0.634
PLT/(×109/L) 185.25±95.79 191.27±88.85 0.364 0.716
N/% 59.03±13.57 59.93±14.31 0.353 0.725
L/% 30.93±11.70 59.93±14.31 -0.791 0.430
ALT/(U/L) 18.5 (12.0, 29.8) 17.0 (13.0, 33.0) -0.795 0.427
AST/(U/L) 20.0 (17.0, 31.2) 23.0 (17.0, 34.0) -1.022 0.307
GGT/(U/L) 21.0 (14.2, 35.0) 25.0 (15.0, 59.0) -1.254 0.210
ALP/(U/L) 67.88±42.58 69.38±31.24 0.231 0.818
Alb/(g/L) 38.21±3.84 38.02±5.17 -0.212 0.833
TBil/(mmol/L) 11.34±5.94 12.83±8.95 0.990 0.324
TBA/(μmol/L) 5.15 (3.55, 7.58) 3.70 (2.00, 7.60) 1.170 0.242
Scr/(mmol/L) 73.70±23.39 68.74±26.70 -1.061 0.291
CRP/(mg/L) 0.27 (0.17, 0.54) 0.28 (0.17, 0.53) -0.669 0.503
ESR/(mm/h) 34.50±25.43 26.59±20.96 -1.762 0.083
RF positivity 34/44 (85.0) 42/85 (49.4) 14.450 <0.05*
RF titer/(IU/mL) 89.8 (31.2, 355.2) 20.5 (0, 84.3) -4.507 <0.05*
ANA positivity 44 (100.0) 91/96 (94.8) 0.325#
ANA titer 320.0 (252.5, 640.0) 160.0 (80.0, 320.0) -4.512 <0.05*
Anti-SSA (+) 43 (97.7) 63 (64.3) 17.945 <0.05*
Anti-Sm (+) 0 (0) 1/93 (1.1) >0.999#
Anti-U1RNP (+) 2/39 (5.1) 12/93 (12.9) 0.230#
Anti-rRNP (+) 1/39 (2.6) 3/92 (3.3) >0.999#
AMA-M2 (+) 2/19 (10.5) 16/45 (35.6) 4.140 0.042*
γG elevation 25/35 (71.4) 25/65 (38.5) 9.890 0.002*
IgG/(g/L) 21.0 (16.0, 30.0) 15.6 (12.5, 19.6) 4.332 <0.05*
IgA/(g/L) 3.60±1.36 3.14±1.39 -1.786 0.076
IgM/(g/L) 1.29±0.83 1.43±1.02 0.782 0.436
C3/(g/L) 0.93±0.24 0.93±0.24 0.057 0.955
C4/(g/L) 0.17 (0.15, 0.22) 0.18 (0.15, 0.21) 0.188 0.851
CD3+/%a 67.2±14.4 76.6±13.1 2.033 0.048*
CD3+CD4+/%a 40.33±9.48 39.37±14.07 -0.211 0.833
CD3+CD8+/%a 40.33±9.48 34.76±18.09 1.967 0.055
CD3-CD19+/%a 21.0±11.9 13.7±9.6 -2.095 0.042*

Table 3

Comparison of treatment between pSS patients with positive and negative anti-SSB antibody"

Items Anti-SSB (+), n=44, n (%) Anti-SSB (-), n=98, n (%) χ2 P
Glucocorticoids 40 (90.9) 72 (73.5) 5.543 0.019*
HCQ 35 (79.5) 71 (72.4) 0.808 0.369
TG 2 (4.5) 2 (2.0) 0.588#
Immunosuppressants 24 (54.5) 36 (36.7) 3.948 0.047*
    CTX 8 (18.2) 15 (15.3) 0.185 0.667
    MMF 9 (20.5) 10 (10.2) 2.753 0.097
    CsA 2 (4.5) 5 (5.1) >0.999#
    TAC 1 (2.3) 0 (0) 0.310#
    LEF 2 (4.5) 4 (4.5) >0.999#
    MTX 1 (2.3) 2 (2.0) >0.999#
    RTX 1 (2.3) 4 (4.1) >0.999#
1 Negrini S , Emmi G , Greco M , et al. Sjögren's syndrome: A systemic autoimmune disease[J]. Clin Exp Med, 2021, 22 (1): 9- 25.
2 Ridgewell D , Thalayasingam N , Ng WF . Sjögren's syndrome: Shedding light on emerging and key drug targets[J]. Expert Opin Ther Targets, 2022, 26 (10): 869- 882.
doi: 10.1080/14728222.2022.2157259
3 Martín-Nares E , Hernández-Molina G . Novel autoantibodies in Sjögren's syndrome: A comprehensive review[J]. Autoimmun Rev, 2019, 18 (2): 192- 198.
doi: 10.1016/j.autrev.2018.09.003
4 Vitali C , Bombardieri S , Jonsson R , et al. Classification criteria for Sjögren's syndrome: A revised version of the European criteria proposed by the American-European Consensus Group[J]. Ann Rheum Dis, 2002, 61 (6): 554- 558.
doi: 10.1136/ard.61.6.554
5 周俞, 吴培豪, 陈素峰, 等. 抗SSA+/SSB+和抗SSA+/SSB-原发性干燥综合征患者临床及实验室特征分析[J]. 中国卫生检验杂志, 2021, 31 (3): 314- 317.
6 黄冬梅, 唐琳, 邓明婷. 抗SSB抗体与原发性干燥综合征女性患者临床的相关性[J]. 现代医药卫生, 2018, 34 (11): 1611- 1614.
doi: 10.3969/j.issn.1009-5519.2018.11.004
7 Thorlacius GE , Hultin-Rosenberg L , Sandling JK , et al. Genetic and clinical basis for two distinct subtypes of primary Sjögren's syndrome[J]. Rheumatology, 2021, 60 (2): 837- 848.
8 Anquetil C , Hachulla E , Machuron F , et al. Is early-onset primary Sjögren's syndrome a worse prognosis form of the disease?[J]. Rheumatology, 2019, 58 (7): 1163- 1167.
doi: 10.1093/rheumatology/key392
9 Lee KA , Choi W , Kim J , et al. Elderly-onset primary Sjögren's syndrome focused on clinical and salivary gland ultrasonographic features[J]. Joint Bone Spine, 2021, 88 (4): 105132.
doi: 10.1016/j.jbspin.2021.105132
10 Shi X , Chen Z , Wang J , et al. Primary Sjögren's syndrome with renal Fanconi syndrome: Good responses to treatment with glucocorticoids[J]. Semin Arthritis Rheum, 2020, 50 (6): 1326- 1332.
doi: 10.1016/j.semarthrit.2020.03.017
11 赵小莹, 白宁, 陈群, 等. 干燥综合征患者血清抗α-胞衬蛋白、抗SSA/SSB抗体、IFN-γ及TNF-α与唇腺病理损害相关性研究[J]. 陕西医学杂志, 2020, 49 (2): 241- 246.
12 Sharma R , Chaudhari KS , Kurien BT , et al. Sjögren's syndrome without focal lymphocytic infiltration of the salivary glands[J]. J Rheumatol, 2020, 47 (3): 394- 399.
doi: 10.3899/jrheum.181443
13 Kim BE , Kwon JS , Choi JH , et al. The association between autoantibody types and salivary gland hypofunction in patients with primary Sjögren's syndrome[J]. J Oral Pathol Med, 2022, 52 (2): 188- 194.
14 Da Cunha E , Mariette X , Desmoulins F , et al. Associations between ocular and extra-ocular assessment in primary Sjögren's syndrome[J]. Joint Bone Spine, 2022, 89 (5): 105426.
doi: 10.1016/j.jbspin.2022.105426
15 Konsta OD , Le Dantec C , Charras A , et al. Defective DNA me-thylation in salivary gland epithelial acini from patients with Sjögren's syndrome is associated with SSB gene expression, anti-SSB/LA detection, and lymphocyte infiltration[J]. J Autoimmun, 2016, 68, 30- 38.
doi: 10.1016/j.jaut.2015.12.002
16 Hong R , Xu D , Hsieh E , et al. Factors associated with renal involvement in primary Sjögren's syndrome: A meta-analysis[J]. Front Med (Lausanne), 2020, 7, 614482.
17 Zhang Y , Qiao L , Zhang L , et al. Renal tubular acidosis and associated factors in patients with primary Sjögren's syndrome: A registry-based study[J]. Clin Rheumatol, 2022, 42 (2): 431- 441.
18 Shi L , Wang J , Guo HX , et al. Circulating Th2 cell reduction and Th1/Th2 imbalance are correlated with primary Sjögren's syndrome-associated interstitial lung disease[J]. Arthritis Res Ther, 2022, 24 (1): 121.
19 La Rocca G , Ferro F , Sambataro G , et al. Primary-Sjögren's-syndrome-related interstitial lung disease: A clinical review discussing current controversies[J]. J Clin Med, 2023, 12 (10): 3428.
20 Wang J , Li M , Wang Q , et al. Pulmonary arterial hypertension associated with primary Sjögren's syndrome: A multicentre cohort study from China[J]. Eur Respir J, 2020, 56 (5): 1902157.
21 陈嘉琪, 张丽宁, 杨建英, 等. 原发性干燥综合征不同抗体阳性患者免疫炎症与疾病活动度特点[J]. 中国免疫学杂志, 2022, 38 (11): 1379- 1382.
22 Lundtoft C , Pucholt P , Martin M , et al. Complement C4 copy number variation is linked to SSA/Ro and SSB/La autoantibodies in systemic inflammatory autoimmune diseases[J]. Arthritis Rheumatol, 2022, 74 (8): 1440- 1450.
23 Huang H , Xie W , Geng Y , et al. Mortality in patients with primary Sjögren's syndrome: A systematic review and meta-analysis[J]. Rheumatology, 2021, 60 (9): 4029- 4038.
24 李德福, 祝婷婷, 庞颖. 原发性干燥综合征相关肺囊性病变的影像学特点及危险因素探讨[J]. 天津医药, 2021, 49 (2): 185- 190.
25 Tani J , Liao HT , Hsu HC , et al. Immune-mediated axonal dysfunction in seropositive and seronegative primary Sjögren's syndrome[J]. Ann Clin Transl Neurol, 2020, 7 (5): 819- 828.
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