4种自身抗体在系统性红斑狼疮诊断及评价活动性中的意义

Significance of four auto antibodies in diagnosis and disease activity in the patients with systemic lupus erythematosus.

目的探讨抗核小体抗体(AnuA)、抗双链DNA抗体(抗ds-DNA抗体)、抗Sm抗体和抗核糖体P蛋白抗体(抗rRNP抗体)在系统性红斑狼疮(SLE)诊断及评价活动性中的意义。方法用免疫印迹法检测SLE患者和其他风湿病患者的AnuA、抗Sm抗体和抗rRNP抗体,酶联免疫吸附法检测抗ds-DNA抗体。并将SLE患者分为基本无活动组、轻度活动组和中重度活动组3组,观察SLE疾病活动度与4种自身抗体阳性率的关系。结果SLE患者中AnuA、抗Sm抗体和抗rRNP抗体的特异性为100%,抗ds-DNA抗体为90.6%;抗ds-DNA抗体的阳性率、敏感度和阴性预测值在4种自身抗体中最高,而抗Sm抗体最低。联合4种自身抗体检测SLE的阳性率为75.8%。抗ds-DNA抗体的阳性率基本无活动组与轻度活动组、中重度活动组比较差异有显著性(P<0.05);AnuA的阳性率各活动度组间比较差异有显著性(P<0.05);抗Sm抗体的阳性率中重度活动组与基本无活动组、轻度活动组的阳性率比较差异有显著性(P<0.05);抗rRNP抗体的阳性率各活动度组间比较差异无显著性(P>0.05)。结论AnuA、抗ds-DNA抗体、抗Sm抗体和抗rRNP抗体对SLE的诊断有重要价值,联合检测可提高SLE诊断的敏感度。AnuA、抗ds-DNA抗体和抗Sm抗体可作于监测SLE疾病活动的指标,而抗rRNP抗体与SLE疾病活动无关。

Objective To evaluate the significance of anti - nucleosome antibodies （ AnuA）, anti - Sin, anti - double stranded dDNA （dsDNA） and anti - ribosomal P protein antibodies （ anti - rRNP） on the diagnosis and the disease flare in patients with systemic lupus erythematosus （SLE）. Methods IMTEC line immunoassay was used to determine serum AnuA, anti - Sm and anti - rRNP in the patients with SLE and other autoimmune disease. Anti - dsDNA in serum was assayed by ELISA. The SLE patients were divided into groups basically no activity, mild activity group and the activities of group 3 with moderate and severe group, SLE disease activity observed with the four kinds of relationship between the positive rates of autoantibodies. Results The specificity of AnuA, anti - Sm and anti - rRNP in the patients with SLE were 100%, anti - dsD- NA were 90.6%. The positive rate, sensitivity and negative predictive value of anti - dsDNA were higher than those of other three auto antibodies, but anti - Sm was opposite. Combined detection of the four auto antibodies improved the sensitivity of SLE diagnosis. The positive rate of anti - ds- DNA significantly lower in SLEDAI 0 - 4 group than those in SLEDAI 〉 4 group （ P 〈 0.05 ）, the rate of AnuA was a significant difference among every degree（ P 〈0.05）, the rate of anti -Sin significantly higher in SLEDAI 〉10 group than those in SLEDAI 〈10 group（ P 〈0.05） , and there was no significant difference of the rate of anti - rRNP among every degree （ P 〉 0.05 ）. Conclusion All of the four auto antibodies are specific markers for diagnosing SLE, and combined detection of them can improve the sensitivity of SLE diagnosis. AnuA, anti -dsDNA and anti - Sm are important auto antibodies in lupus flare, but there is no correlation between anti -rRNP and disease activity for the patients with SLE.