神经精神性红斑狼疮脑脊液抗核抗体的研究

A study on antinuclear antibody of cerebrospinal fluid in patients with neuropsychiatric lupus erythematosus

目的 探讨神经精神性红斑狼疮 (NPLE)患者脑脊液 (CSF)中抗核抗体 (ANA)滴度测定对诊断NPLE的意义以及NPLE可能的发病机制。方法 对 2 5例NPLE患者进行CSFANA检测 ,并与 2 9例无中枢神经系统 (CNS)受累的系统性红斑狼疮 (SLE) (非NPLE)患者及 30例具有CNS病变的非SLE患者的CSFANA进行统计学分析与比较。结果 ①CSFANA≥ 1:80诊断NPLE灵敏度 76 % ,特异度 10 0 % ,阳性预测值 10 0 % ;②NPLE组CSFANA阳性率显著高于非NPLE及非SLE(分别P =0 0 0 0 6 ,P =0 0 0 0 0 )。结论 CSFANA≥ 1∶80为可靠诊断NPLE的检验标准 ;推测ANA导致NPLE的 4条途径。

Objective To detect the antinuclear antibody (ANA) titer of cerebrospinal fluid (CSF) in patients with neuropsychiatric lupus erythematosus (NPLE),evaluate its diagnostic significance to the NPLE and seek for the possible pathogenesis of NPLE.Methods Twenty five NPLE cases received the detection of CSF ANA;as controls were 29 cases of systemic lupus erythematosus (SLE) without central nervous system (CNS) involvement ( abb. non NPLE),and another 30 cases with CNS affection but not belonging to SLE (non SLE);statistical analysis was also made.Results ① CSF ANA≥1∶80 gave a sensitivity 76% and a specificity 100% to the NPLE diagnosis;the forecast positive value was 100%,negative value was 82 9%;positive likelihood ratio was of infinity,negative likelihood ratio was 0 24;② The CSF ANA(+) occurrence both in NPLE group and non NPLE group was obviously higher than that in non SLE (χ 2=37 29, P =0 000 0;χ 2=11 52, P =0 000 7 respectively);the occurrence of CSF ANA(+) and CSF ANA≥1∶80 in NPLE group was significantly higher than that in non NPLE (χ 2=11 65, P =0 000 6;χ 2=34 00, P =0 000 0 respectively);the multiple correlation 2∶1 between the serum ANA titer and CSF ANA titer in NPLE group ran the highest occurrence (24%);the serum ANA titer in NPLE group was markedly higher than that in non NPLE group ( t =2 03, P =0 047).Conclusion CSF ANA ≥1∶80 is a reliable standard for NPLE diagnosis;from CSF ANA detection we can infer there might be four routes of ANA inducing the NPLE.