血清抗神经节苷脂抗体水平与系统性红斑狼疮患者临床特征的相关性研究

Correlation of anti-gangl ioside antibodies with clinical features of systemic lupus erythematosus

目的 初探血清抗神经节苷脂（GM1）抗体与系统性红斑狼疮（SLE）临床特征的相关性.方法 采用改良酶联免疫双抗夹心（ELISA）法,对48例SLE患者血清中的抗GM1-IgM/IgG抗体和抗GQ1b-IgM/IgG抗体水平进行检测,同时检测10例类风湿关节炎（RA）、5例干燥综合征（SS）、1例混和性结缔组织病（MCTD）、1例多发性肌炎（PM）及97名健康对照（HC）的血清样品.对其中5例SLE患者随访3个月,比较前后血清抗体水平.48例SLE患者包括7例神经精神性SLE（NPSLE）与41例非神经精神性SLE（non-NPSLE）患者.以健康对照组99%参考值上限作为阳性界值,进行Fisher确切概率法x2检验、单因素方差分析、Dunnett t检验.结果 首先确立了中国人血清抗GMI-IgM/IgG抗体与抗GQ1b-IgM/IgG抗体的阳性界值,取99%参考值上限,分别为0.411、0.408、0.481和0.441.SLE患者血清抗GM1-IgG抗体水平显著高于对照组（0.33±0.09与0.27±0.05,P〈0.05）,而血清抗GM1-IgM抗体、抗GQ1b-IgM抗体、抗GQ1b-IgG抗体水平在各组中差异无统计学意义（P〉0.05）.根据我们所建立的阳性界值,SLE患者血清抗GM1抗体阳性率为19%（抗GM1-IgM抗体为4%,抗GM1-IgG抗体为15%）.血清抗GM1-IgM/IgG抗体、抗GQ1b-IgM/IgG抗体水平与SLE患者是否伴发神经精神性表现、抗dsDNA-IgG抗体阳性与否及治疗3个月前后SLE疾病活动指数均无明显关联（P〉0.05）.结论 SLE患者外周循环中存在对神经节苷脂GM1的免疫应答,并可能参与了SLE的发病过程.血清抗GM1抗体和抗GQ1b抗体水平和SLE临床特征无明显关联.

Objective To explore the correlation of anti-ganglioside antibodies with clinical features of systemic lupus erythematosus （SLE）. Methods Samples of serum were collected from 48 patients with SLE. Three were male and 45 were female. Their average age was 33±12 （15～59）. The serum anti-ganglioside antibodies of 10 patients with rheumatoid arthritis （RA）, 4 with Sj（o）gren＇s syndrome （SS）, 1 patient with mixed connective tissue disease （MCTD）, 1 with polymyositis （PM）, and 97 healthy controls（HC） were alsoexamined. Levels of anti-GM1-IgM/IgG, anti-GQ1b-IgM/IgG antibodies in the serum were examined by amodified ELISA. Anti-dsDNA-IgG antibody of SLE was tested according to the ELISA kit protocol. The associations of anti-GM1-IgM/IgG and anti-GQ1b-IgM/IgG antibodies with clinical features were analyzed. x2test, one-way ANOVA, Dunnett t-test were used for statistical analysis. Results By using modified ELISA,the upper limit of reference value of anti-GM1-IgM/IgG antibodies, anti -GQ1b-IgM/IgG antibodies in the serum of Chinese SLE patients were 0.411, 0.408, 0.481 and 0.441 res-pectively. 19% patients with SLE were sero-positive for anti-GM1 antibody, 4% for IgM antibody isotype and 15% for IgG antibody isotype. Anti-GM1-IgG antibody was significantly increased in the serum of patients with SLE （0.33±0.09）, higher than that of the HC （0.27±0.05） （P〈0.05）, RA （0.29±0.08）, SS（0.27±0.06）, PM （ 0.288 ）, but one of the MCTD（ 0.423 ）.There was no significant associations between anti-GM1-IgM/IgG, anti-GQ1b-IgM/IgG antibodies and NPSLE and anti-dsDNA-IgG antibody （P〉0.05）. Conclusion Peripheral autoimmune response against GM1 can be detected in SLE patients, and it may be involved in the pathogenesis of SLE. No association of antiGM1-IgM/IgG antibodies or anti-GQ1b-IgM/IgG antibodies with clinical features of SLE can be discovered.