抗核小体抗体在系统性红斑狼疮诊断中的意义

Significance of anti-nucleosome antibodies in diagnosis of systemic lupus erythematosus

目的探讨抗核小体抗体在系统性红斑狼疮(SLE)诊断中的意义和价值。方法应用免疫印迹法检测177例SLE患者,138例其他风湿病患者和56例健康对照者血清中核小体抗体(AnuA)。同时记录SLE患者的临床表现﹑自身抗体和其他检验结果并对AnuA和其他自身抗体进行分析。结果 SLE组AnuA的阳性率明显高于疾病对照组,健康对照组AnuA全为阴性;SLE组AnuA敏感度为48.6%,特异度为95.3%,AnuA的敏感度明显高于抗ds-DNA抗体和抗Sm抗体,差异有统计学意义(P<0.05)。AnuA的特异度高于ANA和组蛋白(P<0.05),AnuA、抗ds-DNA和抗Sm三种抗体联合检测的敏感度为89.8%,明显高于单项检测时的敏感度。AnuA在SLE疾病活动组阳性率明显高于疾病非活动组,且高于ds-DNA抗体(P<0.05)。结论AnuA可能参与了SLE的发病机制,联合检测AnuA等自身抗体,对SLE的正确诊断、病情判断和疗效评估有重要意义。

Objective To explore the significance and value of the anti-nucleosome antibodies（AnuA）in the diagnosis of systemic lupus erythematosus（SLE）.Methods The serum AnuA was detected in 177 patients with SLE,138 patients with other rheumatic diseases and 56 healthy controls by Western blot.The clinical manifestations,autoantibodies and other test results were recorded in the SLE patients.The AnuA and other autoantibodies were analyzed.Results The positive rate of AnuA in the SLE group was significantly higher than that in the disease control group,AnuA was negative in the healthy control group;the sensitivity of AnuA in the SLE group was 48.6% and the specificity was 95.3%;the sensitivity of AnuA was significantly higher than that of the antids-DNA antibodies and anti-Sm antibodies,the difference had statistical significance（P〈0.05）.The specificity of AnuA was higher than that of ANA and histone（P〈0.05）.The sensitivity of joint detection of AnuA,anti-ds-DNA and anti-Sm antibodies was89.8%,which was significantly higher than that of a single index detection.The positive rate of AnuA in the active period of SLE was significantly higher than that of the non-active period,moreover higher than that of the ds-DNA antibodies（P〈0.05）.Conclusion AnuA might participate in the pathogenesis of SLE.The joint detection of autoantibodies including AnuA,etc.has importance significance in the diagnosis,condition judgment and curative efficacy evaluation of SLE.