系统性红斑狼疮患者抗核小体抗体检测的意义

Significance of anti-nucleosome antibodies in systemic lupus erythematosus

目的评价血清抗核小体抗体(ANuA)的检测在系统性红斑狼疮(SLE)患者中的意义。方法用酶联免疫吸附试验(ELISA)检测66例SLE患者,85例其他风湿病患者(包括原发性干燥综合征,多发性肌炎,系统性硬化症,皮肌炎,类风湿性关节炎,强直性脊柱炎和成人Still病)和30例正常对照组血清中的AN-uA,并记录SLE患者的各种临床表现和部分实验室指标,分析其与ANuA的关系。结果SLE患者ANuA的阳性率为65.2%,疾病对照组仅有1.2%的阳性率,正常对照组全部为阴性;SLE患者ANuA阳性率显著高于疾病对照组和正常对照组(P<0.01)。ANuA在SLE检测中的敏感性和特异性分别为65.2%和99.1%,ANuA阳性组的SLE患者在皮疹、脱发和狼疮性肾炎(LN)的发生率分别为90.7%,58.1%和69.8%,明显高于ANuA阴性组34.8%,21.7%和39.1%(P<0.05)。SLE活动期与缓解期患者ANuA阳性率差异具有显著性(P<0.01)。ANuA阳性组与阴性组在免疫球蛋白和补体浓度方面差异无显著性(P>0.05)。ANA、抗dsDNA抗体和抗Sm抗体阴性的SLE患者ANuA的阳性率分别为50.0%,57.1%和64.4%。结论ANuA可作为诊断SLE和判断SLE活动期的一个很有用的指标,尤其对ANA、抗dsDNA抗体和抗Sm抗体阴性及合并LN的SLE的诊断具有重要意义。

[Objective] To evaluate the clinical significance of determining serum anti-nucleosome antibodies （ANuA）in systemic lupus erythematosus（SLE） patients. [Methods] The enzyme-linked immunosorbent assay（ELISA） was used to measure the ANuA in serum of 66 SLE patients, 85 patients with other rheumatic diseases （including primary sjogren＇s syndrome, dermatomyositis, polymyositis, systemic sclerosis, rheumatoid arithritis, ankylosing spondylitis, adult still disease） and 30 healthy controls. And then analyzed the relationships between ANuA and the clinical manifestations or some other laboratory resuhs in the SLE patients. [Results] Of 66 SLE patients 65.2% were seropositive for ANuA. In contrast, only 1.2% of 85 control patients were seropositive （P 〈0.01） and none of the healthy controls were seropositive （P 〈0.01）. The sensitivity and specificity of ANuA in SLE were 65.2% and 99.1% respectively. The incidences of erythra, alopeeia and lupus nephritis（LN） in ANuA positive SLE patients were 90.7%, 58.1%, 69.8% respectively and significantly higher than those of ANuA negative SLE patients（34.8%,21.7%, 39.1%） （P 〈0.05）. The positive rate of ANuA was significantly different between the active and the relieved SLE patients （P 〈0.01）. There were no significant difference in immunoglobulins and complements between positive and negative ANuA of SLE patients （P 〉0.05）. The positive rates of ANuA in SLE patients with negative anti-nuclear antibodies （ANA）, anti-dsDNA and anti-Smith antibodies were 50.0%, 57.1%, 64.4% respectively. [Conclusion] ANuA may be a useful tool for the diagnosis and activity assessment in SLE patients, especially in the patients with negative ANA, anti-dsDNA or anti-Smith antibodies and the patients with ,lupus nephritis.