自身抗体、免疫学指标、D-二聚体和纤维蛋白联合检测对系统性红斑狼疮的诊断价值

Diagnostic value of combined detection of autoantibodies, immunological indicators, D-dimer and fibrin for systemic lupus erythematosus

目的探讨自身抗体、免疫学指标、D-二聚体(DD)和纤维蛋白(FIB)联合检测对系统性红斑狼疮(SLE)的诊断价值。方法选取2017年1月至2018年6月西航医院收治的60例SLE患者进行研究,将其作为观察组,根据患者是否处于活动期分为活动期组(32例)和非活动期组(28例)。选择同时期在我院进行健康体检的60例健康体检者作为对照组,两组受检者均采用间接免疫荧光法、免疫印迹法检测自身抗体、免疫功能指标以及DD、FIB水平,其中自身抗体包括抗双链DNA(dsDNA)抗体、核抗体(ANA)、核小体(Nucleosome)、组蛋白(Histone)和抗核糖体P蛋白抗体(ARPA),免疫功能指标包括免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、干扰素α(IFN-α)、白细胞介素6 (IL-6)、白细胞介素10 (IL-10),分析自身抗体、免疫学指标以及DD、FIB水平与SLE的相关性。结果观察组患者的自身抗体dsDNA、ANA、Nucleosome、Histone和ARPA的检测结果阳性率分别为38.33%、91.67%、36.67%、28.33%及38.33%,对照组分别为0、1.67%、0、0以及0,观察组患者的自身抗体检测结果均显著高于对照组,差异均具有统计学意义(P<0.05);活动期组患者的IgA、IgG、IgM、IFN-α、IL-6、IL-10水平分别为(3.32±1.03) g/L、(21.54±4.33) g/L、(2.42±0.84) g/L、(21.22±7.93) pg/mL、(14.47±3.22) pg/mL及(14.35±4.11) pg/mL,非活动期分别为(1.98±0.72) g/L、(17.01±3.34) g/L、(1.67±0.49) g/L、(12.97±4.25) pg/mL、(10.41±2.22) pg/mL及(10.32±2.11) pg/m L,对照组分别为(1.23±0.54) g/L、(9.67±1.77) g/L、(1.22±0.31) g/L、(6.97±1.65) pg/m L、(5.77±1.55) pg/m L及(6.34±1.54) pg/mL,活动期组各项指标的检测结果均明显高于非活动期组,非活动期组又明显高于对照组,差异均具有统计学意义(P<0.05);活动期组患者的DD、FIB水平分别为(5.12±1.08) mg/L、(6.38±1.54) g/L,非活动期组分别为(1.54±0.36) mg/L、(3.76±0.76) g/L,对照组分别为(0.43±0.11) mg/L、(2.13±0.35) g/L,活动期组的DD、FIB水平均明显高于非活动期组,非活动期组又明显高于对照组,差异均具有统计学意义(P<0.05)。结论系统性红斑狼疮患者自身抗体阳性检出率较高,免疫功能指标、DD、FIB水平均显著升高,并且与疾病活动度密切相关,因此联合检测自身抗体、免疫功能指标以及DD、FIB水平,不仅有助于诊断,而且还能够判断病情发展程度,值得临床推广应用。

Objective To explore the diagnostic value of combined detection of autoantibodies,immunological indicators,D-dimer (DD) and fibrin (FIB) for systemic lupus erythematosus (SLE).Methods A total of 60 SLE patients admitted to Xihang Hospital from January 2017 to June 2018 were selected for study and used as observation group.They were divided into active group (32 cases) and inactive group (28 cases) according to whether the patient was active.60 healthy people who underwent physical examination in the hospital during the same period were selected as a control group.Both groups were tested for autoantibodies,immune function indicators,DD and FIB levels by indirect immunofluorescence and immunoblotting.Autoantibodies included anti-double-stranded DNA (dsDNA) antibodies,nuclear antibodies (ANA),nucleosome,histone,and anti-ribosomal P protein antibody (ARPA).Immunological function indicators included immunoglobulin A (IgA),immunoglobulin G (IgG),immunoglobulin M (IgM),interferon-alpha (IFN-α),interleukin-6 (IL-6),and interleukin-10 (IL-10).The correlation was analyzed between SLE and autoantibodies, immunological indicators,DD and FIB levels.Results The positive rates of autoantibodies such as dsDNA (38.33% vs 0),ANA (91.67% vs 1.67%),Nucleosome (36.67% vs 0),Histone (28.33% vs 0),and ARPA (38.33% vs 0) in the observation group were significantly higher than those in the control group (P<0.05).The immune function indicators of patients in the active group were IgA (3.32 ± 1.03) g/L,IgG (21.54 ± 4.33) g/L,IgM (2.42 ± 0.84) g/L,IFN-α(21.22±7.93) pg/mL,IL-6 (14.47±3.22) pg/mL,and IL-10 (14.35±4.11) pg/mL;those in the inactive group were IgA (1.98±0.72) g/L,IgG (17.01±3.34) g/L,IgM (1.67±0.49) g/L,IFN-α(12.97±4.25) pg/mL,IL-6 (10.41±2.22) pg/mL,and IL-10 (10.32±2.11) pg/mL;and those in the control group were IgA (1.23±0.54) g/L,IgG (9.67±1.77) g/L,IgM (1.22± 0.31) g/L,IFN-α(6.97±1.65) pg/mL,IL-6 (5.77±1.55) pg/mL,and IL-10 (6.34±1.54) pg/mL.The results of the active group were significantly higher than those in the inactive group,and the inactive group was significantly higher than the control group,all differences were statistically significant (P<0.05).The DD and FIB levels in the active group were respectively (5.12±1.08) mg/L and (6.38±1.54) g/L,those in the inactive group were respectively (1.54±0.36) mg/L and (3.76±0.76) g/L,and in the control group were respectively (0.43±0.11) mg/L and (2.13±0.35) g/L.The DD and FIB levels in the active group were significantly higher than those in the control group,and the inactive group was significantly higher than the control group (P<0.05).Conclusion The positive detection rate of autoantibodies in patients with systemic lupus erythematosus is higher.The levels of immune function indicators,DD and FIB are significantly increased, which are closely related to disease activity.Therefore,the combined detection of autoantibodies,immune function indicators, and DD and FIB levels,not only contribute to diagnosis,but also to judge the degree of disease progression, which is worthy of clinical application.