儿童系统性红斑狼疮患者血清抗核小体抗体检测

Value of Anti-nucleosome Antibody in the Diagnosis of Juvenile Systemic Lupus Erythematosus

目的探讨抗核小体抗体(anti-nucleosome antibodies,AnuA)对儿童系统性红斑狼疮(systemic lupus erythematosus,SLE)诊断的意义,并与成人SLE进行比较。方法选取87例儿童SLE患者,30例非SLE儿童疾病对照组(包括幼年类风湿关节炎、脊柱关节病、皮肌炎、干燥综合征和血管炎),122例成人SLE和55例其他结缔组织病患者,采用酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)检测血清AnuA。结果 87例儿童SLE中67例AnuA阳性,30例儿童疾病对照组中2例AnuA阳性,AnuA对儿童SLE诊断的敏感性和特异性分别为77.01%和93.33%,ROC曲线下面积为0.852;阳性预测值和阴性预测值分别为97.10%和58.33%。AnuA对成人SLE患者诊断的敏感度和特异度分别为68.85%和90.91%。AnuA对儿童SLE诊断的敏感度高于成人SLE,对儿童SLE诊断的特异度与成人比较无明显差异(P>0.05)。在抗dsDNA抗体和抗Sm抗体阴性的儿童SLE患者中AnuA的阳性率分别为56.52%(26/46)和76.71%(56/73)。结论 AnuA对儿童SLE的诊断具有较高的敏感度和特异度,有助于抗dsDNA抗体和抗Sm抗体阴性儿童SLE的诊断。

Objective To evaluate the diagnostic value of anti-nucleosome antibodies （AnuA） in juvenile systemic lupus erythematosus （SLE） and compare that with adult SLE.Methods We included 87 children and 122 adults with SLE.As control groups, we included 30 children and 55 adults with other connective tissue disease.ELISA was used to measure AnuA.Results Out of 87 juvenile SLE patients, 67 （77.01%） were seropositive for AnuA, which was significantly higher than that of patients with other rheumatic diseases （6.67%, P0.05）.The sensitivities and specificities of AnuA for juvenile SLE diagnosis were 77.01% and 93.33% , respectively.The positive predictive value and negative predictive value were 97.10% and 58.33% , respectively.The sensitivity of AnuA in juvenile SLE was higher than that in adult SLE.The specificit in juvenile and adult SLE.The positive rate of AnuA in SLE without anti-dsDNA and anti-Sm antibodies were 56.52% and 76.71% , respectively.Conclusion The detection of AnuA is useful for diagnosis of juvenile SLE, especially in patients who are negative for anti-dsDNA antibodies and anti-Sm antibodies.