抗内皮细胞抗体在狼疮性肾炎临床和病理改变中的意义

The significance of antiendothelial cell antibodies in patients with lupus nephritis: A clinical and renal pathological study

目的探讨抗内皮细胞抗体在狼疮性肾炎临床和病理改变中的意义。方法采用细胞酶联免疫吸附实验（ＥＬＩＳＡ），对５８例狼疮性肾炎病人血清进行抗内皮细胞抗体检测，并以提取的内皮细胞蛋白为抗原，应用免疫印迹方法对抗内皮细胞抗体的抗原进行了分析。结果在５８例狼疮性肾炎病人中抗内皮细胞抗体的阳性率为３６％，抗内皮细胞抗体阳性病人具有血小板减少发生率增高（２４％），血清ＩｇＧ水平增高（１３±７）ｇ／Ｌ，Ｃ３水平降低以及抗核抗体谱中多种抗体阳性率增高倾向。抗内皮细胞抗体可识别内皮细胞分子量１２０００～９００００的多种蛋白成分，在伴有大量蛋白尿的狼疮性肾炎病人中，同时与内皮细胞分子量２７０００，２９０００抗原相结合抗体的阳性率（３４％）明显高于非大量蛋白尿的病人（４％）（Ｐ＜０．０５）；在肾小球微血栓检出阳性的狼疮性肾炎病人中，与内皮细胞２９０００抗原相结合抗体的阳性率（６０％）明显高于未检出肾小球微血栓的病人（１４％）。结论抗内皮细胞抗体阳性狼疮性肾炎病人，常伴有较严重的自身免疫紊乱；

Objective To investigate the prevalence and possible role of antiendothelial cell antibodies(AECA)in the pathogenesis of lupus nephritis. Methods Sera from 58 patients with lupus nephritis were studied. Cellular ELISA were used to detect AECA, and immunoblotting was performed to determine specific endothelial target.Results 36% of the patients with lupus nephritis had elevated IgG AECA. IgG AECA was correlated with the higher incidence of thrombocytopenia, higher serum immuoglobulin G levels, lower serum C 3 (13±7) g/L and higher titers of antibodies against nucli and dsDNA. AECA consisted of a group of heterogeneous antibodies and reacted with different endothelial cell antigens ranging from 12 000 to 90 000 in molecular size. A correlation was demonstrated between heavy proteinuria (>3.5 g/24 hr) and the existence of antibodies simultaneously against the 27 000, 29 000 endothelial cell antigens (34% vs 4%), we also found an association between the presence of glomerular capillary thrombi and antibody against the 29 000 endothelial cell antigen (60% vs 14%). Conclusion These results suggested that lupus nephritis patients with AECA showed a complex autoimmune disorder and provided an indirect evidence that AECA might contribute to the pathogenesis of lupus nephritis.