系统性红斑狼疮患者多种自身抗体联合检测的临床意义

The clinical significance of combined detection of autoantibodies in systemic lupus erythematosus

目的探讨血清抗核抗体(ANA)、抗可溶性抗原(ENA)抗体共16项自身抗体联合检测在系统性红斑狼疮(SLE)诊断中的应用价值。方法收集90例SLE患者、90例风湿性疾病患者和90例健康者血清,采用间接免疫荧光法检测ANA,采用蛋白质免疫印迹法检测其他15项抗体。结果 90例SLE患者ANA、抗核糖体核糖蛋白抗体(抗nRNP)、抗Smith抗体(抗Sm)、抗干燥综合征A抗体(抗SSA)、抗Ro-52抗体、抗双链DNA抗体(抗ds-DNA)、抗核小体抗体(AnuA)、组蛋白(AHA)和抗核糖体P蛋白抗体(ARPA)检测阳性率分别为97.8%、56.7%、33.3%、77.8%、70.0%、35.6%、38.9%、33.3%和43.3%,均高于风湿性疾病患者组和健康对照组,差异有统计学意义(P<0.05)。ANA灵敏度、阴性预测值最高,特异性最低。除ANA以外,抗nRNP/Sm、ARPA、AnuA、抗SSA、抗ds-DNA、抗Sm的正确指数均较高。抗Sm、抗ds-DNA、AnuA、ARPA、抗nRNP/Sm特异性及阳性预测值较高,此5种自身抗体具有互补关系。结论 ANA因灵敏度高,特异性低,只适宜作为SLE的筛选指标。抗Sm、抗ds-DNA、AnuA、ARPA、抗nRNP/Sm对SLE具有较高的特异性,与ANA联合检测可互相弥补其缺陷,有利于SLE的诊断和治疗。

Objective To study the clinical significance of combined diction of 16 sorts of serum autoantibod- ies, including antinuclear antibody（ANA）, anti-ENA, et al. Methods Serum samples of patients group with sys- temic lupus erythematosus （SLE, n = 90）, comparison group with other auto-immune diseases （n = 90） and normal control group（n= 90） were detected for ANA by indirect immunofluorescence assay and for the other fifteen antibodies by Western blot. Results The positive rates of ANA, anti-rRNP/sm, anti-sin, anti-SSA, anti-Ro-52,ds-DNA, AnuA, AHA and ARPA among 90 cases of patients group with SLE were respectively 97.8%, 56.7%, 33.3%, 77.8%, 70.0%, 35.6%, 38.9%, 33.3% and 43.3%, and the positive rates of other antibodies were higher than comparison group and normal control group（P〈0.05）. Sensitivity and negative predictive value of ANA was the highest, but specificity was the lowest. Except for ANA, anti-rRNP/sm, ARPA, AnuA, anti-SSA, ds-DNA and anti-Sm were with higher right index. Anti-sm, ds-DNA, AnuA, ARPA and anti-rRNP/sm were with high specific- ity and positive predictive value, which were complement with each other. Conclusion ANA might be with high sen- sitivity and low specificity, hence it could be suitable only for SLE screening test. For anti-Sm, ds-DNA, AnuA, ARPA and anti-rRNP/sm could have high specificity with SLE. Combined detection of these antibodies might mini- mize the limitations of single detection, and be useful in diagnosis and treatment of SLE.