抗增殖型细胞核抗原抗体在系统性红斑狼疮患者的临床意义

Clinical Significance of Anti-Proliferating Cell Nuclear Antigen Antibodies in Systemic Lupus Erythematosu

目的探讨抗增殖型细胞核抗原(PCNA)抗体在系统性红斑狼疮(SLE)患者中的意义及临床相关性。方法采用间接免疫荧光法(IIF)检测抗PCNA抗体,并用线性免疫印迹法将部分IIF-抗PCNA抗体阳性的患者血清进行特异性抗体检测。结果抗PCNA抗体阳性患者55例,包括SLE24例,占43%,未分化结缔组织病(UCTD)8例,占15%,系统性硬化症(SSc)8例,占15%。SLE组与各疾病组在IIF-抗PCNA抗体滴度分别为1:80～1:160、1:320～1:640和≥1:1280,其构成比,SLE组与UCTD组,差异无统计学意义(χ2=2.464,P>0.05);SLE组与SSc组,差异有统计学意义(χ2=7.232;P<0.05);SLE组与其他疾病组,差异有统计学意义(χ2=13.104,P<0.01)。SLE患者荧光滴度以高滴度为主。伴随抗PCNA抗体出现的特异性抗体,SLE组阳性抗体包括抗双链DNA(dsDNA)、抗干燥综合征抗原A(SSA)、抗史密斯抗原(Sm)、抗核糖核蛋白(nRNP)/Sm、抗组蛋白(Histone,Hi)、抗核小体(Nukleosome,Nuk)、抗核糖体P蛋白(rRNP)、抗干燥综合征抗原B(SSB)抗体;UCTD组为抗Hi、抗nRNP/Sm、抗SSA、抗rRNP抗体阳性。抗PCNA抗体阳性患者的临床表现,SLE患者中皮肤、肾脏、关节、神经、水肿、低补体血症病变高发。结论抗PCNA抗体是临床少见的自身抗体,主要见于SLE患者,但并不是SLE的特异性抗体,还可出现在其他自身免疫性疾病(AID)及非AID患者中。当其荧光滴度较高或与其他特异性抗体组合出现时,临床应警惕有明确或处在进展中的SLE;在其他AID及非AID患者中抗PCNA抗体往往单独出现,并且荧光滴度较低。

Objective To explore the significance and the relevance between anti-proliferating cell nuclear antigen（PCNA） antibody and clinical manifestations of systemic lupus erythematosus（SLE）.Methods The serum antinuclear antibodies was detected by indirect immunofluorescence（IIF）,anti-PCNA antibody was screened from anti-PCNA antibody-positive patients,and specific antibody was measured by line immunoassay（LIA） method in part of IIF-PCNA positive patients.Results The results indicated that there were 55 PCNA antibody-positive patients,in which 24 cases（43%） were systemic lupus erythematosus（SLE） cases,8（15%） were undifferentiated connective tissue disease（UCTD）,8（15%） were systemic sclerosis（SSc）.PCNA antibody had the highest positive percentage in SLE patients.The percentage of patients with IIF-PCNA titers of 1：80-1：160,1：320-1：640 and ≥1：1280 were analyzed between SLE and other groups.The results showed that the difference between SLE group and UCTD group was not statistically significant（x2=2.464,P0.05）,there are statistically significant differences between group SLE and SSc groups（x2=7.232,P0.05）,however,the difference was significant between SLE patients and patients with other diseases（x2=13.104,P0.01）.It suggested that the titer was at the highest rank in fluorescence in patients with SLE in patients with positive anti-PCNA antibodies,other specific antibodies,including anti-double stranded DNA（anti-dsDNA）,anti-Sjogren＇ s syndrome antigen A（anti-SSA）,anti-Smith antigen（anti-Sm）,anti-nuclear ribonucleoprotein（anti-nRNP）/Sm,anti-Histone（anti-Hi）,anti-Nukleosome（anti-Nuk）,anti-ribosomal protein（anti-rRNP） antibodies,anti-Sjogren＇ s syndrome antigen B（anti-SSB）,anti-CTD group of anti-Hi,nRNP/Sm,anti-SSA,anti-rRNP antibodies were positive in SLE patients.Patients with positive anti-PCNA antibody had higher prevalence of skin lesions,renal involvement,arthritis,neurological damage and edema.Conclusions The results showes that anti-PCNA antibody is a relatively rare antibodies,mostly are found in SLE patient,but it is not specific for SLE,since it can be detected in other autoimmune diseases（AID） and NAID patients.When high titer anti-PCNA antibody is detected or it is co-appeared with other auto-antibodies,it highly suggests that SLE may be present or SLE is at the evolving stage.Anti-PCNA antibody may be the an isolated antibody in other AID and NAID patients,and the titer is usually low.