93例系统性红斑狼疮中医辨证分型的抗核抗体谱与肿瘤坏死因子分析

Analysis on anti-nuclear antibody repertorie and tumor necrosis factor of 93 cases of systemic lupus erythematosus by TCM syndrome differentiation

目的:比较系统性红斑狼疮(SLE)患者不同中医证型与其免疫指标的关系,为辨证分型提供客观依据。方法:将93例SLE患者分为阴虚内热证、瘀热痹阻证、脾肾阳虚证、风湿热痹证4组。抗核抗体(ANA)采用间接免疫荧光法(IIF)、抗ENA抗体采用免疫印记法(IBT)、抗ds-DNA抗体采用斑点免疫金渗滤法、肿瘤坏死因子(TNF)采用放射免疫法(RIA)。结果:抗核抗体滴度风湿热痹组抗核抗体滴度与脾肾阳虚组之间有显著性差异(P<0.05),抗ENA抗体按阳性率比较各组无差异,但瘀热痹阻组与脾肾阳虚组13.5kD抗体有差异(P<0.05),17.5kD抗体有差异(P<0.01);瘀热痹阻组与风湿热痹组比较17.5kD抗体有差异(P<0.01);瘀热痹阻组与阴虚内热组比较13.5kD抗体有差异(P<0.05);阴虚内热组与脾肾阳虚组73kD抗体有差异(P<0.05)。抗ds-DNA抗体风湿热痹组与脾肾阳虚组、瘀热痹阻组比较有显著差异(P<0.01),与阴虚内热组比较有差异(P<0.05)。TNF脾肾阳虚组与风湿热痹组比较有差异(P<0.05)。结论:①抗ds-DNA抗体可作为中医"虚实辨证"的参考。②IBT法检测的73kD、17.5kD、13.5kD条带可作为辨证分型的参考依据。③ANA抗体滴度和TNF值与辨证分型密切相关,可以作为急性期和缓解期的参考指标。

Objective： To study the relationship between the differential syndrome patterns in traditional Chinese medicine （TCM） and immunology reference in patients with systemic lupus erythematous （SLE）,and to provide a objective reference on TCM diagnosis of SLE.Methods. Methods： 93 cases of SLE were divided into four traditional chinese medicine syndrome pattern groups： （1）Feng-Shi-Re-Bi group （2）Yin-Xu-Nei-Re group（3） Pi-Shen-Yang-Xu group （4） Yu-Re-Bi-Zu group. We selected indirect immunofluorescence（ Ⅱ F） on ANA, IBT on anti-ENA antibody,dot the infiltration of immune on anti-ds- DNA antibody, Tumor necrosis factor （TNF）on RIA .Results： There was a significant difference on the titer of anti-nuclear antibody between Feng-Shi-Re-Bi group and Pi-Shen-Yang-Xu group （P 〈0.05）, anti-ENA antibodies by the positive rate of all groups no difference, but Yu-Re-Bi-Zu group and Pi-Shen-Yang-Xu groupon13.5 kd antibody group differences （P〈0.05）, 17.5 kd antibody difference （P〈0.01）; Feng-Shi-Re-Bi group and Yu-Re-Bi-Zu group 17.5 kd antibody differences （P〈0.01）;Yu-Re-Bi- Zu group and Yin-Xu-Nei-Re group 13.5 kd antibody difference （P〈0.05）; Yin-Xu-Nei-Re group and Pi-Shen-Yang-Xu group73 kd antibody difference （P〈0.05）. On anti-ds-DNA antibody Feng-Shi-Re-Bi group and Pi-Sben-Yang-Xu group,Yu-Re-Bi-Zu group significant difference （P〈0.01）,compared with Yin-Xu-Nei-Re group difference（P〈0.05）.On TNF Pi-Shen-Yang-Xu group and Feng-Shi-Re-Bi group difference（P〈0.05）.Conclusion： Firstly, anti-ds-DNA antibody can become a reference of the Xu- Shi syndrome patterns; Secondly,73kd, 17.5kd, 13.5kd strips in IBT can become a reference of the syndrome patterns in TCM. Thirdly, the titers of ANA and the value of TNF are correlation with the syndrome patterns in TCM ,and can be used as reference for the acute phase and remission phase.