三种自身抗体联合检测对狼疮疾病活动和狼疮肾炎的价值

Significance of combination of three autoantibodies in systemic lupus erythematosus with lupus flare and lupus nephritis

目的探讨联合检测抗C1q抗体、抗核小体抗体(AnuA)和抗dsDNA抗体对狼疮活动和狼疮肾炎(LN)的价值。方法 90例系统性红斑狼疮(SLE)分为疾病活动和疾病稳定组、LN和非LN组, 酶联免疫吸附试验(ELISA)检测血清抗C1q抗体和AnuA水平,间接免疫荧光法比较三抗体单个和联合对疾病活动和LN的价值。结果抗C1q抗体、AnuA和抗dsDNA抗体阳性对疾病活动的敏感性分别为 71．4％、75．0％和66．1％,特异性分别为75．5％、70．6％和88．2％;抗dsDNA抗体阴性患者分别有36．7％抗 C1q抗体阳性和26．5％AnuA阳性。疾病活动组三抗体阳性率和抗体水平显著高于疾病稳定组;三抗体与 SLE疾病活动指数(SLEDAI)、血沉(ESR)、IgG、球蛋白水平显著正相关,与C3、C4及白蛋白水平显著负相关。LN组三抗体水平显著高于非LN组。结论三抗体都是狼疮疾病活动的指标,都与LN有关,联合检测可以提高疾病活动检出率。

Objective To explore the significance of anti-C1q, anti-nucleosome （AnuA） and anti-dsDNA Abs in lupus flare and lupus nephritis. Methods Anti-C1q, AnuA and anti-dsDNA Abs were detected at the same time in 90 SLE patients using ELISA and indirect immunofluorescence respectively. Differences of three types antibodies were compared between lupus flare and stable, patients with and without lupus nephritis. Results The sensitivity and specificity of anti-C1q, AnuA and anti-dsDNA Abs for lupus flare were 71.4%, 75,0% and 66.1%; 75.5%, 70.6% and 88.2% respectively. The sensitivity of combination of three antibodies for lupus flare was 83.3%. There were 36.7% patients with anti-C1q and 26.5% patients with AnuA in lupus patients lacking anti-dsDNA antibodies. Serum levels of three antibodies in patients with disease flare and lupus nephritis patients were greater than patients with stable disease and without lupus nephritis. Three antibodies correlated with SLEDA1, IgG and globulin positively correlated with serum level of C3, C4 and albumin negatively. Conclusion Three antibodies are important autoantibodies in lupus flare and correlate with lupus nephritis. Combination of three antibodies can promote the diagnosis of lupus flare.