抗核小体抗体对儿童系统性红斑狼疮诊断价值及与疾病活动度的相关性研究

The value of antinucleosome antibody in diagnosis of juvenile systemic lupus erythematosus and the association with disease activity

目的评价抗核小体抗体（AnuA）单独及与抗核抗体、抗Sm抗体和抗双链DNA（dsDNA）抗体联合检测对儿童系统性红斑狼疮（JSLE）的诊断价值，探讨AnuA与临床特点的相关性。方法选取80例JSLE患者，56例非SLE的儿童疾病对照组，包括结缔组织病、白塞病、脊柱关节病、类风湿关节炎、皮肌炎、硬皮病，并留血清待检。采用酶联免疫吸附法（ELISA）检测血清AnuA，间接免疫荧光法检测抗核抗体；联合ELISA法和间接免疫荧光法检测抗dsDNA抗体，其中任一种检测方法结果阳性即判为阳性；免疫印迹法检测抗Sm抗体，并记录JSLE患者的临床特点。收集同期临床资料及相关实验室检查结果，进行SLE疾病活动指数（SLEDAI）评分，分析JSLE患者AnuA抗体与上述指标的相关性。结果AnuA对JSLE诊断的敏感度为76．25％，特异度为98．21％。AnuA与抗dsDNA抗体及抗Sm抗体联合检测的敏感度分别为83，05％、86，44％，特异度96．43％、98．21％，敏感度明显高于二者单项检测的敏感度，差异有统计学意义（P〈0．01）。AnuA与红细胞、血红蛋白呈负相关（r值分别为-0．499、-0．503，P值分别为0．000、0．000），与红细胞沉降率（ESR）、血尿、低补体、抗dsDNA抗体呈正相关（r值分别为0．388、0．227、0．303、0．531，P值分别为0．000、0．042、0．006、0．000），与SLEDAI评分呈正相关（r=0．303，P=0．000）。结论AunA对JSLE的诊断具有较高的敏感度和特异度，与抗dsDNA抗体和抗Sm抗体联合检测可以提高诊断的敏感度。AunA不仅可以作为JSLE的诊断指标，还可以评估疾病活动性，具有较高的临床应用价值。

Objective To evaluate the frequency of antinucleosome antibody （AnuA） in juvenile systemic lupus erythematosus （JSLE）, comparing it to that observed for anti-dsDNA, anti-Sin antibodies, and explore the correlation of these antibodies with clinical manifestations and disease activity. Methods We included 80 children with JSLE and 56 children with other rheumatic diseases into this study. Clinical records were reviewed. AnuA, antinuclear antibody （ANA） and anti-Sm antibody were detected by ELISA, IIF and Western-blot respectively. Anti-DNA were detected by ELISA and IIF. Disease activity was assessed by SLEDAI score. Results AnuA showed sensitivity of 76.25% and specificity of 98.21%. AnuA combine with anti-dsDNA antibody or anti-Sm antibody was detected, the sensitivities and specificities were 83.05% , 86.44% and 96.43%, 98.21%, respectively. It showed that the sensitivity was higher than any one of the three. The presence of AnuA was associated with red blood cell count, hemoglobin level, ESR, hematuria, low complement levels and anti-dsDNA antibody （r=-0.499, -0.503, 0.388, 0.227, 0.303, 0.531, P=0.000, 0.000, 0.000, 0.042, 0.006, 0.000）. The presence of AnuA was associated with the SLEDAI score （P=- 0.000）. Conclusion AunA has the highest sensitivity and specificity among these autoabtibodies, particularly, when combined with anti-dsDNA antibody or anti-Sin antibody. The level of AnuA is associated with the disease activity of JSLE. AnuA is not only useful for the diagnosis of JSLE but also for evaluation ofthe disease activity.