抗核抗体系列检测对狼疮性肾炎进行鉴别诊断的临床意义

Clinical significance of antinuclear antibody series in patients with lupus nephritis

目的探讨抗核抗体（ANA）系列指标在狼疮性肾炎（LN）患者中的表达情况及临床意义。方法对406例系统性红斑狼疮（SLE）患者（其中LN122例）和74例其他自身免疫病患者及120例健康体检者采用间接免疫荧光法测定ANA，应用欧蒙印迹法测定ANA系列。结果SLE患者ANA阳性率为94．49％，其他自身免疫病组ANA阳性率为55．41％，二者相比，r=0．754，P=0．019，差异有统计学意义；SLE患者及其他自身免疫病患者与正常对照组相比，r=0．983，P=0．001，差异有统计学意义。LN组ANA系列中，8个检测项目阳性率均高于不伴肾炎的SLE组，r=0．452，P=0．036，差异有统计学意义。抗双链DNA抗体＋抗Sm抗体＋抗nRNP抗体同时阳性时，LN组阳性表达显著高于不伴肾炎的SLE组，r=0．601，P=0．02。当抗双链DNA抗体阳性时，LN组抗组蛋白抗体、抗核小体抗体和抗核糖体P蛋白抗体同时阳性的表达也显著高于不伴肾炎的SLE组，r=0．617，P=0．022。结论ANA及ANA系列的联合检测可以相互补充，对提高LN的诊断率及判断预后、指导治疗等方面具有重要意义。

Objective To investigate the expression and clinical significance of the results on antinuclear antibody（ ANA） series examination in patients with lupus nephritis （LN）. Methods ANA series were detected by EUROIMMUN blotting test in serum of 406 patients with systemic lupus erythematosus （SLE） （a- mong them, 122 were diagnosed with lupus nephritis）, 74 with other autoimmune disease （AID） and 120 health controls. Positive expression and the relative level of ANA expression were further confirmed by indirect Immunofluorescence assays. Results In serum of SLE patients, the positive rate of ANA examination were 94.49%, as compared with 55.41% in the other AID group, r =0. 754,P =0.019. In LN group, the parallel positive rate of 8 items of ANA series was significantly higher than that in SLE with no concurrent nephritis group, r = 0. 452 ,P = 0.036. Simultaneous positive rate of anti-ds DNA, anti-Sm and anti-nRNP antibodies in LN group was 20.87% , as compared with 7.06% in SLE patients with no concurrent nephritis, r = 0. 601, P = 0. 02）. Furthermore, while anti-ds DNA antibody was positive, the parallel positive rate of anti-histone, anti- nucleosome and anti-Rib P antibodies was 21.33% versus 6.47% in LN and SLE without nephritis group, respectively, r = 0. 617 ,P = 0.022. Conclusion Combined ANA and ANA series examination may better diagnose patients with LN from other SLE patients and thus be of clinical significance in prognosis and providing rational adjuvant-therapies for such patients.