系统性红斑狼疮患者自身抗体联合检测的意义

The significance of combined detection of autoantibodies in SLE

目的探讨抗核抗体(ANA),抗双链DNA(dsDNA)抗体,抗Smith(Sm)抗体和抗核小体抗体(AnuA)四种自身抗体单项及联合检测在系统性红斑狼疮(SLE)的诊断中的价值。方法测定56例SLE患者,108例其他结缔组织病患者及50例健康人群血清中的自身抗体。以间接免疫荧光法测定ANA,抗dsDNA抗体;以免疫印迹法测定抗Sm抗体,酶联免疫吸附试验(ELISA)测定AnuA。结果56例SLE患者血清自身抗体检测中:ANA、抗dsDNA抗体、抗Sm抗体、AnuA阳性率分别为:91.0%、44.6%、35.7%、64.3%;特异性分别为:70.9%,100%,98.7%,98.1%。在抗dsDNA抗体,抗Sm抗体,AnuA三者中,任何一项检测结果阴性时,其他两种自身抗体均出现一定阳性率,并以AnuA在抗dsDNA抗体、抗Sm抗体阴性时阳性检出率最高,达51.6%和61.1%。三者联合检测阳性率为83.9%。结论在检测的四种自身抗体中以ANA敏感性最高,其他三种特异性均可达97%以上,除AnuA敏感性稍高,其他两项检测值均低于50%。三者联合检测可较大程度提高SLE检测阳性率,并且特异性也与单独检测差异无显著性,且三者具有明显的互补作用。

Objective To investigate the specificity and sensitivity of autoantibody analyses for antinuclear antibody （ ANA）, anti - double stranded DNA antibody （anti -dsDNA）, anti -Smith antibody （anti -Sm） and antinuclesome antibody （AnuA） in systemic lupus erythematosus （ SLE）, and evaluate the significance of combined detection of these autoantibodies in the diagnosis of SLE. Methods Fifty - six patients with SLE, 108 patients with other autoinlmune diseases and 50 healthy people were studied. ANA and anti - dsDNA were detected by indirect immunofluorescence assay, anti - Sm was detected by Western blot and AnuA was detected by ELISA. Results In the assays mentioned above, the serum positive rates of ANA, anti - dsDNA, anti - Sm and AnuA were 91%, 44.6%, 35.7% and 64.3%, and the specificities were 70.9%, 100%, 98.7%, and 98.1% respectively in patients with SLE. Among the antibodies of anti - dsDNA antibody, anti - Sm, and AnuA, when one anti- body was negative, other two might show positive in some cases, and the highest positive rate of AnuA could reach 51.6% and 61.1% when anti - dsDNA and anti - Sm were negative. The positive rate of combined determination of anti - dsDNA, anti - Sm and AnuA was 87.1%. Conclusion The sensitivity of ANA detection is the highest, however, the sensitivities of the detection of other antoantibodies in this study is less than 50%. The specificity of the detection of anti - dsDNA, anti - Sm and AnuA is over 97%. The combined determination of anti - dsDNA, anti - Sm and Anna improves the sensitivity of the detection for SLE without obvious change of the specificity. The detections of the three antibodies are complementary for the diagnosis of SLE.