血清抗C1q抗体在系统性红斑狼疮患者中的临床价值

The clinical value of anti-c1q antibodies in patients with systemic lupus erythematosus

目的探讨血清抗C1q抗体在系统性红斑狼疮(SLE)患者狼疮肾炎(LN)以及疾病活动中的临床价值。方法采用ELISA法检测102例SLE患者以及35例正常对照组血清中抗C1q抗体水平,比较分析其与SLE病情活动指数(SLEDAI)评分、疾病活动性指标抗双链DNA(ds-DNA)抗体、补体C3、C4水平、超敏C反应蛋白(hs-CRP)以及肾脏损害指标24 h尿蛋白定量(24 h UPQ)、肌酐(Cr)、尿素氮(BUN)的相关性,以及通过联合检测抗ds-DNA抗体以及抗核小体抗体(Anu A)判断其在SLE中的临床价值。结果总体SLE患者抗C1q抗体敏感性为55.9%,特异性为94.3%,在SLE中其抗体水平显著高于正常对照组,其中疾病活动LN组、疾病稳定LN组和疾病活动非LN组抗C1q抗体水平明显高于疾病稳定非LN组水平,差异有统计学意义(P<0.01),而疾病稳定LN组、疾病活动LN组与疾病活动非LN组之间比较,差异无统计学意义。在疾病活动期中,抗C1q抗体水平与SLEDAI评分、ds-DNA、hs-CRP呈正相关性(P<0.05),与C4呈负相关性(P<0.05),C3和24 h UPQ仅在疾病活动LN组中呈相关性;在疾病稳定期中,抗C1q抗体水平只有在疾病活动和疾病稳定LN组中与24 h UPQ呈正相关性,与C3、C4呈负相关性。联合检测抗ds-DNA抗体、Anu A、抗C1q抗体显著提高稳定期LN的诊断价值。结论抗C1q抗体对SLE的诊断和LN判断有重要临床价值,抗C1q抗体参与了SLE肾脏损害的发病机制,联合检测抗dsDNA抗体、Anu A、抗C1q抗体有助于SLE稳定期肾脏损害的诊断。

Objective To explore the clinical value of serum anti-Clq antibodies in systemic lupus erythematosus （SLE） patients with disease activity and lupus nephritis （LN）. Methods ELISA method was used to detect the level of serum anti-C1 q antibodies in 102 eases of SLE patients and 35 eases of healthy controls, comparative analy- sis with SLE disease activity index（SLEDAI） score, disease activity index anti-double-stranded DNA （anti-dsDNA） antibodies, complement C3 and C4 level, hypersensitive C-reactive protein （hs-CRP） and kidney damage index 24 h urine protein quantitative （24 h UPQ）, creatinine （Cr）, urea nitrogen （BUN）, and through joint detection of anti-dsDNA antibodies and anti-nueleosome resistance antibodies （AnuA） determine the clinical value in SLE. Re- suits The sensitivity and specificity of antiel q antibodies in SLE were 55.9% and 94.3 % , antibody level （ 15.45 ±16.41） RU/ml was significantly higher than that in normal control group （5.43 ＋3.18） RU/ml, The anti-C1q anti-body levels in disease activity group and disease stable with LN group （26.47± 22. 16;20.22 ± 14. 96;19. 18 ± 15.71 ）RU/ml were significantly higher than those in diseasestable non LN group （6.24±5.52 ）RU/ml （P 〈 0. 01 ） , there was no statistically significant difference in disease activity group and disease stable with LN group. In disease activity period, The anti-C1q antibody level and the SLEDAI score, ds-DNA, hs-CRP were positively correlated （ P 〈 0.05 ）, and were negatively correlated with C4 （ P 〈 0.05 ）, while the C3 and 24 h UPQ only were correlated in disease activity with LN; In stable period, 24 h UPQ were positively correlated, and were negatively correlated with C3 and C4 in LN group. Joint detection of anti-dsDNA antibodies, AnuA and anti-Clq antibodies significantly increase the diagnostic value stability in lupus nephritis. Conclusion The anti-Clq anti-body in the diagnosis of SLE and the judgment of LN had important clinical value; the anti-C1q antibody was involved in the pathogenesis of SLE renal damage, combined detection of anti-dsDNA antibodies, AnuA and anti-C1q antibody helping the diagnosis of SLE stabilization kidney damage.