抗C1q抗体及抗ENA抗体与系统性红斑狼疮疾病活动和肾脏受累的关系

Relationship of anti-C1q antibodies and anti-ENA antibodies with disease activity and nephric impairment in systemic lupus erythematosus

目的探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)患者血清中抗C1q抗体及抗ENA抗体与SLE疾病活动状态和肾脏受累的关系,揭示抗C1q抗体、抗ENA抗体在疾病诊断及评判中的临床价值。方法将来自本院123例SLE患者按疾病活动状态以及是否满足狼疮性肾炎(lupus nephritis,LN)诊断条件分为LN活动组、非LN活动组、LN稳定组和非LN稳定组。患者24 h内收集血、尿标本,分别用ELISA法检测抗C1q抗体;斑点印迹法检测抗ENA抗体;干式化学法检测尿蛋白;用全自动生化分析仪检测血β2微球蛋白(β2-MG)和肌酐(CREA)。结果β2-MG阳性率:LN活动组与非LN活动组(88.6%vs 59.4%)、LN稳定组与非LN稳定组(66.1%vs 47.4%)比较差异有统计学意义(P<0.05,P<0.01);CREA阳性率:LN稳定组与非LN稳定组相比差异有显著性(27.8%vs 0.0%,P<0.01);尿蛋白"++++"阳性率:LN活动组(42.9%)与非LN活动组(12.5%)、非LN稳定组(2.6%)比较差异有统计学意义(P<0.05,P<0.01);抗C1q抗体阳性率:LN活动组与非LN稳定组相比差异有统计学意义(68.6%vs 36.8%,P<0.05)。抗C1q抗体阳性与阴性组间尿蛋白"++++"、"+"阳性率比较差异有显著性(26.2%vs 11.3%,14.8%vs 38.7%,P<0.05)。结论 SLE患者肾脏损害常发生于疾病活动期,抗C1q抗体和部分抗ENA抗体可能是加重肾脏损害的因素。实验室监测抗C1q抗体及β2-MG的水平对预测SLE患者肾脏损害有积极指导意义。

Objective To investigate the relationship of serum anti-C1q antibodies and anti-extractable nuclear antigen（anti-ENA） antibodies with disease activity and nephric impairment in systemic lupus erythematosus（SLE） for clinical values of the 2 antibodies in diagnosis and evaluation of the disease.Methods A total of 123 cases of SLE patients who admitted in our hospital in recent 1 year were divided into 4 groups according to SLE activity and lupus nephritis（LN）,that is,LN activity group（n=35）;non-LN activity group（n=32）;LN stable group（n=18） and non-LN stable group（n=38）.Serum and urine specimens of SLE patients was collected within 24 h of first hospitalization.Anti-C1q antibodies were detected by ELISA,and anti-ENA antibodies were assayed by dot blotting.Dry chemistry method was used to detect urinary protein.β2-microglobulin（β2-MG） and creatinine（CREA） was assayed using the automatic biochemical analyzer.Results β2-MG positive rate in LN activity group（88.6%） was significantly higher than non-LN activity group（59.4%）and LN stable group（66.1%）（both P0.05）,and was still significantly higher than non-LN stable group（47.4%）（P0.01）.The positive rate of CREA in stable group of LN（27.8%）was significantly higher than stable group of non-LN（0.0%）（P0.01）.Urine protein characterized as ＂＋ ＋ ＋ ＋＂ positive rate in LN activity group（42.9%）was significantly higher than non-LN activity group（12.5%）and non-LN stable group（2.6%）（P0.05,0.01）.Anti-C1q antibody positive rate was significantly higher in LN activity group（68.8%） than in non-LN stable group（36.8%）（P0.05）.Significant differences were found in urinary protein as a ＂＋ ＋ ＋ ＋＂ and ＂＋＂ positive rate in anti-C1q antibody-negative group and the anti-C1q antibody positive group（26.2% vs 11.3%,14.8% vs 38.7%,P0.05）.Conclusion In SLE patients,nephric impairment occur when disease in activity.Presence of anti-C1q antibodies and anti-ENA antibodies may aggravate the impairment.And to those patients,standard monitoring of anti-C1q antibodies and β2-MG is of significance to forecast the kidney damage.