抗核小体抗体、抗C1q抗体和抗双链DNA抗体在狼疮肾炎诊断中的意义

Significance of anti-nucleosome antibody,anti-C1q antibody and anti-double stranded DNA antibody in diagnosis of lupus nephritis

目的:通过抗核小体抗体、抗C1q抗体和抗双链DNA(dsDNA)抗体检测,观察3种抗体阳性的狼疮肾炎(LN)患者实验室检查和临床特征,阐明系统性红斑狼疮(SLE)并发LN的危险因素及3种抗体在LN诊断中的意义。方法:选择SLE患者120例,其中LN组60例,非LN组60例,回顾性分析2组患者抗核抗体谱及抗C1q抗体的差异;比较LN组患者抗核小体抗体、抗C1q抗体和抗dsDNA抗体3种抗体阳性的LN患者(三阳性LN组)和非抗体阳性的LN患者(非三阳性LN组)的临床表现及实验室检查的差异。结果:LN组患者抗C1q抗体阳性率为40.00%,非LN组患者抗C1q抗体阳性率为21.67%,2组患者抗C1q抗体阳性率比较差异有统计学意义(χ2=4.728,P=0.03);LN组患者抗dsDNA抗体阳性率为66.67%,非LN组患者抗dsDNA抗体阳性率为46.67%,2组患者抗dsDNA抗体阳性率比较差异有统计学意义(χ2=4.887,P=0.027);LN组患者抗核小体抗体阳性率为58.33%,非LN组患者抗核小体抗体阳性率为40.00%,2组患者抗核小体抗体阳性率比较差异有统计学意义(χ2=4.034,P=0.045);其余抗体U1-snRNP、SmD1、Jo-1、SSA/Ro60kD、SSA/Ro52kD、SSB、scl-70、CENP-B和P0抗体阳性率组间比较差异均无统计学意义(P>0.05)。三阳性LN组与非三阳性LN组患者年龄及免疫球蛋白、C反应蛋白(CRP)、血沉、白细胞和血小板检测结果比较差异均无统计学意义(P>0.05),三阳性LN组患者补体C3、补体C4和血红蛋白水平较非三阳性LN组降低(P<0.05)。三阳性LN组和非三阳性LN组患者不同临床症状发生率比较差异无统计学意义(P>0.05)。结论:抗核小体抗体、抗C1q抗体和抗dsDNA抗体是SLE并发LN的危险因素,三抗体阳性可提高LN的诊断率,三阳性LN组患者补体和血液系统方面损害更严重,肾疾病活动度更高。

Objective： To investigate the clinical and laboratory characteristics of lupus nephritis （LN） patients by detecting the anti-nucleosome antibodies, anti-Clq antibodies and anti-double stranded antibodies （anti-ds DNA）, and to clarify the risk factors of LN in the patients with systemic lupus erythematosus （SLE）, and the significance of three kinds of antibodies in diagnosis of LN. Methods： A total of 120 SLE patients were selected and divided into LN group （n=60） and non-LN group （n= 60）. The ANAS data of 120 patients were retrospectively analyzed, the levels of anti-Clq antibodies were measured. The clinical symptoms and laboratory data of the patients with positive anti-dsDNA, -nueleosome and -Clq antibodies （3-pos group ） and negative three kinds of antibodies （non 3-pos group） were analyzed in LN group. Results： The positive rate of anti-Clq antibody of the patients in LN group （40.00%） was higher than that in non-LN group （21.67%） （X^2 =4. 728, P=0.03）. The positive rate of anti-dsDNA antibody in LN group was 66.67%, and it was 46. 67% in non-LN group; the positive rates of the patients had significant difference between two groups （X^2 = 4. 887, P= 0. 027）. The positive rate of anti- nucleosome antibody in LN group was 58.33%, and it was 40.00% in non-LN group; the positive rates of the patients had significant difference between two groups （X^2=4. 034, P=0. 045）. The positive rates of UI-snRNP, StuD1 and other antibodies Jo-1, SSA/Ro60kD, SSA/Ro52kD, SSB, ScL-70, CENP-B, and P0 had no significant differences between two groups （P〉0.05）. The levels of C3 and C4 and hemoglobinin of the patients in 3-pos group were higher than those innon 3-pos group （P〈0.05） ; the age, the levels of immunoglobulin protein and C- reactive protein （CRP）, and erythrocyte sedimentation rate （ESR）, white blood cell （WBC） and platelet had no statistically significant differences between 3-pos and non 3-pos groups （P〉0.05）. The clinical symptoms were not statistically significant in a-pos and non 3-pos groups （P〉0.05）. Conclusion： The anti-nucleosome, anti-Clq and anti-dsDNA antibodies are the risk factors of SLE complicated with LN; the positive antibodies can improve the diagnostic rate of LN. The 3-pos patients have more severe damage in complements and blood system with higher renal disease activities.