自身抗体联合检测在系统性红斑狼疮诊断中的临床价值

Clinical value of combined detection of autoantibodies in the diagnosis of systemic lupus erythematosus

目的探讨抗核抗体(ANA)、抗Sm抗体、抗dsDNA抗体、抗核糖体P蛋白抗体(抗rRNP)、抗核小体抗体(AnuA)等5种自身抗体联合检测在系统性红斑狼疮(SLE)诊断中的临床价值。方法采用间接免疫荧光法和免疫印迹法检测45例SLE患者(A组),38例非SLE自身免疫性疾病患者(B组)及33例健康体检者(C组)血清ANA、抗Sm抗体、抗dsDNA抗体、抗rRNP抗体和AnuA。参照SLE疾病活动性指数评分标准将SLE患者分为活动期A1组与非活动期A2组,分析SLE疾病活动度与5种自身抗体的关系。结果A组血清ANA、抗Sm抗体、抗dsDNA抗体、抗rRNP和AnuA阳性率均高于B组(P<0.05)和C组(P<0.01);A组血清ANA的灵敏度大于抗Sm抗体、抗dsDNA抗体、抗rRNP抗体和AnuA(P<0.05);抗Sm抗体、抗dsDNA抗体和抗rRNP抗体、AnuA的特异度大于ANA;ANA、抗Sm抗体、抗dsDNA抗体和抗rRNP抗体、AnuA联合检测的特异度为100%,对SLE的诊断效率最高。A1组与A2组血清ANA和抗Sm的阳性率相仿(P>0.05)。结论联合检测血清ANA、抗Sm抗体、抗dsDNA抗体和抗rRNP、AnuA可以提高SLE诊断的灵敏度和特异度。抗dsDNA抗体、抗rRNP抗体和AnuA可以用于监测SLE的疾病活动度。

Objective To investigate the clinical value of combined detection of the autoantibodies of serum antinuclear antibodies（ANA）,Sm antibodies,anti dsDNA resistance,resistance to ribosomal P protein antibodies（rRNP）,anti-nucleosome antibodies（AnuA）in the diagnosis of systemic lupus erythematosus（SLE）.Methods By indirect immunofluorescence（IIF）and Western blot method,serum levels of ANA,Sm antibody resistance,anti-dsDNA antibodies,rRNP,AnuA were detected in 45 SLE patients（group A）,38 SLE patients with autoimmune diseases（group B）and 33 healthy people（group C）.On the basis of the standards of SLE disease activity index score,the patients in group A were divided into groups of A1（active SLE）and A2（non-active SLE）and the relationship of SLE disease activity and the five kinds of autoantibodies.Results The positive rates of ANA,Sm antibody resistance,anti dsDNA antibodies,rRNP and AnuA were higher in group A than those in group B（P〈0.05）and group C（P〈0.01）.The sensitivity of serum ANA in group A was significantly greater than that of Sm antibody resistance,anti-dsDNA antibodies,rRNP and AnuA（P〈0.05）,The specificity of Sm antibodies,anti-dsDNA resistance,rRNP and AnuA was significantly greater than that of ANA.The positive rate was 100% when combined detection of ANA,Sm antibodies,anti-dsDNA,rRNP and AnuA,which provided the highest diagnosis rate of SLE.The positive rates of ANA,Sm antibody were not significantly different between groups of A1 and A2（P〉0.05）.Conclusion Combined detection of the autoantibodies of serum ANA,Sm antibodies,anti-dsDNA,rRNP,and AnuA can improve the sensitivity and specificity for the diagnosis of SLE.The anti-dsDNA antibodies,rRNP and AnuA can be used in monitoring the disease activity of SLE patients.