抗SmD1抗体对系统性红斑狼疮诊断性能的研究

The Study of Diagnostic Value of Anti-SmD1 Antibody on Systemic Lupus Erythematosus

目的评价抗SmD1抗体对系统性红斑狼疮(SLE)的诊断性能。方法采用ELISA法检测60例SLE患者(SLE组)、54例其他自身免疫疾病患者(其他自身免疫疾病组,其他组)、50例健康成人(对照组)血清抗SmD1抗体,间接免疫荧光法检测抗双链DNA(dsDNA)抗体,免疫斑点法检测抗Sm抗体、抗核小体抗体(AnuA)、抗核糖体P蛋白抗体(ARPA)。结果 SLE组抗SmD1抗体水平与阳性率分别为31.55(13.98~128.84)U/mL及53.3%(32/60),明显高于其他组[13.48(12.50~19.80)U/mL,14.8%(8/54)]及对照组[13.62(12.50~17.93)U/mL,2.0%(1/50)(P<0.01)]。在5种SLE诊断指标中,以抗SmD1抗体对SLE的诊断敏感性53.3%(32/60)、阴性预测值77.2%(95/123)、准确性77.4%(127/164)为最高;相关性分析显示抗SmD1抗体与AnuA,ARPA之间不具分布的一致性(P>0.05)。将抗SmD1抗体与传统SLE诊断指标(抗dsDNA抗体、抗Sm抗体、AnuA及ARPA)联合检测可将对SLE的诊断敏感性提高至71.7%(33.3%),且与抗SmD1抗体单项检测比较,差别具有统计学意义(P<0.05);其ROC曲线达0.827,高于抗SmD1抗体单项检测(0.733)与传统SLE诊断指标联合检测(0.765)。结论抗SmD1抗体对SLE具有良好的诊断性能,且与传统SLE诊断指标之间具一定互补性;将抗SmD1抗体与传统SLE诊断指标联合检测可进一步提高对SLE的诊断敏感性。

Objective To evaluate the diagnostic value of anti-SmD1 antibody in systemic lupus erythematosus （SLE）.Methods In serum samples from 60 cases with SLE,54 cases with other autoimmune disease,and 50 healthy persons （control group）,following were studied： levels of anti-SmD1 antibody by ELISA,anti-double strain DNA （dsDNA） antibody by indirect immunofluorescent assay,as well as anti-Sm antibody by immunoblotting assay,anti-nucleosome antibody （AnuA） by immunoblotting assay,and anti-ribosomal P protein antibody （ARPA） by immunoblotting assay.Results The level and positive rate of serum anti-SmD1 antibody in SLE group were 31.55（13.98~128.84） U/mL and 53.3%（32/60）,which were significantly higher than that in other autoimmune disease group 13.48（12.50~19.80） U/mL,14.8%（8/54） and control group 13.62（12.50~17.93） U/mL,2.0%（1/50） （P〈0.01）.Among 5 SLE serological markers,anti-SmD1 antibody showed the highest diagnostic sensitivity of 53.3% （32/60）,negative predictive value of 77.2% （95/123） and accuracy of 77.4%（127/164）.Meanwhile,there were no significant consistencies on distribution of anti-SmD1 antibody with AnuA and ARPA in SLE group （P〉0.05）.The combined detection of anti-SmD1 antibody with conventional serological markers including anti-dsDNA antibody,anti-Sm antibody,AnuA and ARPA increased the sensitivity to 71.7% （33.3%）,which was significantly higher than detection of anti-SmD1 antibody alone.Furthermore,the area under receiver operating characteristic curve ROC of the combined detection of anti-SmD1 antibody with conventional serological markers was 0.827,which was higher than detection of anti-SmD1 antibody （0.733） alone or the detection of conventional serological markers combined （0.765）.Conclusions Anti-SmD1 antibody has favorable diagnostic value over the conventional serological markers,and it has complementary effect when used with the conventional serological markers in SLE.The combined detection of anti-SmD1 antibody with conventional serological markers contributes to increased diagnostic sensitivity of SLE.