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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#
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