抗dsDNA抗体、抗Sm抗体、AnuA和抗rRNP抗体联合检测对系统性红斑狼疮的诊断价值

THE CLINICAL VALUATION IN THE DIAGNOSTIC OF SYSTEMIC LUPUS ERYTHEMATOSUS OF COMBINED DETECTION OF ANTI-DSDNA ANTIBODY,ANTI-SM ANTIBODY,ANTI-NUCLEOSOME ANTIBODY AND ANTI-RRNP ANTIBODY

目的探讨抗ds DNA抗体、抗Sm抗体、Anu A和抗rRNP抗体联合检测在系统性红斑狼疮(SLE)诊断中的临床应用价值。方法选取96例SLE患者;77例非SLE疾病对照组,包括类风湿关节炎(RA)46例,原发性干燥综合征(p SS)11例,系统性硬皮病(SSc)10例,其他结缔组织病(CTD)10例;30例健康人对照组。用间接免疫荧光法检测抗双链DNA抗体,用免疫印迹法检测抗Sm抗体、Anu A、抗rRNP抗体。结果 96例SLE患者抗ds DNA抗体、抗Sm抗体、Anu A和抗rRNP抗体的敏感性分别为57%、23%、41%和30%,明显高于疾病对照组,差异有显著性(p<0.01),30例健康对照组检测结果全部为阴性。4种抗体检测的特异性分别为99%、100%、98%和96%,对疾病诊断特异性无明显改变(p>0.05)。4种抗体联合检测可提高对SLE阳性检出率,其检测敏感性可提高到86%;在41例抗ds DNA阴性SLE患者中抗Sm抗体阳性率为26.8%(11/41)、Anu A阳性率为9.8%(4/41)、抗rRNP抗体阳性率为31.7%(13/41)。结论抗ds DNA抗体、抗Sm抗体、Anu A和抗rRNP抗体在SLE的诊断有很高的特异性,敏感性各不相同,以抗ds DNA敏感性最高;4种特异性抗体在SLE诊断中有明显的互补作用,联合检测可提高对SLE的诊断水平,有利于SLE早期诊断、疗效观察以及病情监测追踪,具有重要临床意义。

Objective To investigate the clinical application value of combined detection of anti - dsDNA antibody, anti- Sm antibody, anti -nucleosome antibody（AnuA） and anti- rRNP antibody in diagnosis of systemic lupus erythematosus （SLE） patients. Methods 96 cases of SLE patients were selected, with 77 cases of non - SLE disease in control group that consist of 46 rheumatoid arthritis （RA） patients, 11 primary Sjogren~ syndrome （pSS） patients, 10 systemic scleroderma （SSc） patients and 10 other connective tissue disease （CTD） patients. 30 cases of healthy people were selected as control subjects for observation. The anti - dsDNA antibody was detected by indirect assay （IIF） ; Western blotting was used to detect anti -Sm antibody, AnuA and anti -rRNP an- tibody. Results The sensitivity of anti - dsDNA antibody, anti - Sm antibody, AnuA and anti - rRNP antibody were 57%, 23%, 41% and 30% in 96 cases of SLE patients. They were much higher than those of control groups, and the difference was significant （p 〈0.01 ）. 30 healthy controls were all negative. The specificity was 99%, 100% , 98% and 96%. The disease diagnosis specificity did not change obviously （p 〉 0.05）. Combined antibodies detec- tion of those 4 kinds can increase the positive rate of SLE, and the detection sensitivity can be improved to 86%. In 41 anti - dsDNA negative cases of SLE patients, anti - Sm antibodies positive rate was 26.8% （ 11 of 41 ） ; AnuA positive rate was9.8% （4 of 41） ; and anti -rRNP antibody positive was 31.7% （13 of 41）. Conclusion The an- ti - dsDNA antibody, anti -Sm antibodies, AnuA and anti - rRNP have high specificity in SLE diagnosis, and the anti -dsDNA sensitivity was highest of the different sensitivity. 4 kinds of specific antibody with a complementary effect are obvious in the diagnosis of SLE. Combined detection may improve the diagnosis level of patients with SLE, including the early diagnosis of SLE, observation of curative effect and monitoring to the disease state tracking. It has important clinical significance.