抗类瓜氨酸化抗体在系统性红斑狼疮中的意义

Significance of anti-carbamylated fibrinogen antibodies in systemic lupus erythematosus

目的:探讨抗类瓜氨酸化抗体(anti-carbamylated fibrinogen antibodies,抗CarP抗体)在系统性红斑狼疮(systemic lupus erythematosus,SLE)中的意义,SLE是否与类风湿关节炎(rheumatoid arthritis,RA)一样,存在大量针对类瓜氨酸的自身抗体,抗CarP抗体与关节损伤及疾病活动度高度相关。方法:利用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)检测105例确诊的SLE患者和73例健康对照者血清中抗CarP抗体水平,收集其他SLE相关临床和实验室数据,采用SPSS 24.0软件进行相应统计学分析。结果:SLE中存在抗CarP抗体,且明显高于健康对照组(P<0.05)。抗CarP抗体阳性组与阴性组SLE患者相比,在以下临床及实验室指标方面差异有统计学意义:病程、血沉(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)、类风湿因子(rheumatoid factor,RF)、抗心磷脂抗体、抗dsDNA抗体、D-二聚体、IgA、IgG、补体C3、补体C4、外周血红细胞计数和血红蛋白水平(P<0.05)。与SLE其他自身抗体相比,抗CarP抗体的阳性率(21.9%)高于抗Sm抗体(15.24%),与抗核糖体P蛋白抗体(22.86%)阳性率相似;在SLE特异性抗体阴性的患者中可检测到抗CarP抗体,其阳性率分别为:抗Sm(-)组20.2%(18/89),抗dsDNA(-)组9.3%(4/43),抗核小体抗体(-)组12.5%(6/48)和抗核糖体P蛋白抗体(-)组20.9%(17/81)。而且,抗CarP抗体水平与病程、补体C3、补体C4、红细胞及血红蛋白呈明显负相关(P<0.05),与ESR、CRP、IgA、IgG、RF、抗心磷脂抗体、抗dsDNA抗体及D-二聚体呈明显正相关(P<0.05)。结论:SLE患者血清中抗CarP抗体水平升高,抗CarP抗体与SLE患者临床及实验室指标具有相关性。

Objective:Antibodies against carbamylated protein(anti-CarP)were found to be a promising marker to evaluate joint damage and disease activity in patients with rheumatoid arthritis(RA).However,whether anti-CarP antibodies were present in systemic lupus erythematosus(SLE)remained ambiguity.We have therefore undertaken this study to assess the levels of serum anti-CarP antibodies and to evaluate their clinical value in SLE.Methods:Serum levels of antibodies against carbamylated-fibrinogen(anti-CarP)were measured by enzyme-linked immunosorbent assay(ELISA)in 105 SLE patients and 73 healthy controls.Other clinical and laboratory measurements of the SLE patients were collected from medical records.Data analyses between anti-CarP antibodies and other laboratory measurements were performed using SPSS software for Windows 24.0.Results:The levels of serum anti-CarP antibodies in the patients with SLE were significantly higher than those in the healthy controls(P<0.05).There were significant differences between the anti-CarP-positive group and anti-CarP-negative group in many clinical features.The disease duration,values of ESR,CRP,RF,anti-cardiolipin,anti-dsDNA,D-dipolymer,IgA and IgG were significantly higher in the anti-CarP-positive group compared with the negative group(P<0.05).Conversely,the values of complement 3,complement 4,peripheral blood RBC,and hemoglobin were significantly lower in anti-CarP-positive group than in the negative group(P<0.05).Moreover,the incidence of increase of erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),rheumatoid factor(RF),D-dipolymer,decrease of peripheral blood RBC,hemoglobin,complement 3,complement 4,and positive rate of anti-dsDNA were significant different between the two groups(P<0.05).The positive rate of anti-CarP(21.9%)was higher than that of anti-Sm(15.24%),and close to anti-ribosomal P protein(22.86%)in our SLE patients.In addition,anti-CarP antibody was present in the SLE patients lacking the disease specific antibodies,including anti-Sm(anti-CarP positive rate 20.2%,18/89),anti-dsDNA(anti-CarP positive rate 9.3%,4/43),anti-nucleosome(anti-CarP positive rate 12.5%,6/48),and anti-ribosomal P protein antibody(anti-CarP positive rate 20.9%,17/81).Moreover,the high levels of anti-CarP antibodies were correlated with short disease duration,low C3,C4,RBC,and hemoglobin(P<0.05),high ESR,CRP,IgA,IgG,RF,anti-cardiolipin,anti-dsDNA,and D-dipolymer(P<0.05).Conclusion:The level of anti-CarP antibody was increased in the serum of patients with SLE.There were correlations between anti-CarP antibodies and clinical and laboratory indicators of SLE patients.