抗神经元抗体的检测及其在狼疮中枢神经系统病变中的临床应用研究

The detection of anti-neuronal antibodies and its diagnostic value to central nervous system involvement of systemic lupus erythematosus

目的 建立检测抗神经元抗体 (anti neuronalantibodies,anti N)的细胞 ELISA方法 ,并评价其对系统性红斑狼疮中枢神经系统病变 (CNS SLE)的诊断价值。方法 以 1%多聚甲醛固定的SK N MC成神经瘤细胞株为抗原 ,采用细胞 ELISA方法 ,检测 12 3份血清 (包括CNS SLE 2 8例 ,无中枢神经系统受累的SLE 2 2例 ,其他结缔组织病 36例 ,正常血清 37例 )和 138份脑脊液 (包括CNS SLE 38例 ,无中枢神经系统受累的SLE 2 9例 ,其他结缔组织病 12例 ,有神经精神症状的其他疾病 5 9例 )中anti N。结果 血清中anti N在SLE中阳性率为 6 2 0 % (31/ 5 0 ) ,特异性为 91 8% ;脑脊液中anti N在CNS SLE中阳性率为 47 4% (18/ 38) ,特异性为 89 7% ,而无中枢神经系统受累的SLE (non CNS SLE)阳性率仅为 10 3 % (3/ 2 9) ,且抗体水平低于前者 ,二者在抗体水平和阳性率上差异存在显著性 (P均 <0 0 0 1) ;以意识障碍 /精神症状为主要表现的CNS SLE脑脊液中该抗体阳性率最高 ,分别为 75 0 %和 72 7% ,显著高于其他类型CNS SLE (P =0 0 1) ;8例CNS SLE患者治疗前后脑脊液中anti N水平分别为 0 47± 0 2 2和 0 2 2± 0 0 6 ,二者之间差异有显著性 (P <0 0 5 )。结论 血清中anti N对诊断SLE特异性较高 ;脑脊液中anti

Objective To develop a cell ELISA method detecting anti neuronal antibodies (anti N),and evaluate the diagnostic value of these antibodies to central nervous system involvement of systemic lupus erythematosus (CNS SLE).Method All 123 sera (28 with CNS SLE,22 with non CNS SLE,36 with other CTDs and 37 normal controls) and 138 cerebrospinal fluids (CSF) (38 with CNS SLE,29 with non CNS SLE,12 with other CTDs and 59 with neurologic manifestations without CTDs) were assayed for anti N by a cell ELISA method using 1% paraformaldehyde fixed SK N MC neuroblastoma cell line.Results ① Sera anti N levels were significantly elevated in patients with SLE,with the sensitivity of 62 0%(31/50) and specificity of 91 8%;while there was no significant difference between CNS SLE and non CNS SLE in sera anti N ( P >0 05).② CSF anti N levels were significantly elevated in CNS SLE,with the sensitivity of 47 4%(18/38) and specificity of 89 7%;while only 10 3%(3/29) of non CNS SLE showed anti N in CSF ( P <0 001).And CNS SLE with acute confusional state or psychiatric disorder had relatively higher level of anti N than other CNS SLE ( P =0 01),with the sensitivity of 75 0% and 72 7% respectively.Anti N levels were significantly decreased after treatment ( P <0 05).Conclusion Sera anti N has high specificity for SLE;while CSF anti N is sensitive and specific for CNS SLE,and anti N level is associated with disease activity of CNS SLE.