不同方法检测抗双链DNA抗体在系统性红斑狼疮诊断中的价值评估

The Assessment on Diagnostic Value of Different Methods for Detection ofAnti-Double Stranded DNA Antibody in Systemic Lupus Erythematosus

目的评估流式荧光法(FFIA)、间接免疫荧光法(IIF)及酶联免疫吸附法(ELISA)检测抗双链DNA(dsDNA)抗体用于系统性红斑狼疮(SLE)诊断的临床价值,为临床实践寻找适宜的检测策略。方法选取我院就诊的SLE患者92例,非SLE自身免疫性疾病患者127例及50例健康体检者,分别采用FFIA、IIF和ELISA检测血清中抗dsDNA抗体,计算各方法检测灵敏度和特异性,采用Kappa检验评估结果一致性,采用受试者工作特征曲线(ROC曲线)比较各方法用于区分SLE和非SLE自身免疫性疾病的效能。结果用FFIA、IIF、ELISA检测抗dsDNA抗体,SLE组阳性率分别为44.6%、50.0%和62.0%,均高于疾病对照组和健康对照组(P<0.0001)。IIF与FFIA、ELISA具有高度的一致性,Kappa值分别为0.64和0.72。FFIA与ELISA检测结果具有中等的一致性,Kappa值为0.56。以串联的方式FFIA-IIF或ELISA-IIF联合检测,可提高SLE诊断的灵敏度,分别达到59.8%和67.4%,其特异性分别为92.1%和89.3%,阴阳性与诊断符合率分别提高到81.0%和81.8%。ROC曲线分析显示,FFIA的AUC最大,达到0.768,ELISA和IIF的AUC分别为0.748和0.711。结论FFIA、ELISA和IIF检测抗dsDNA抗体具有较好的一致性,用于SLE诊断的准确性高。ELISA-IIF或FFIA-IIF(串联)联合检测,可作为临床实践中适用于SLE诊断的抗dsDNA抗体检测模式。

Objective To evaluate the clinical application value of anti-double stranded DNA(dsDNA)antibody detected by flowcytometry fluorescence immunoassay(FFIA),indirect immunofluorescence(IIF)and enzyme-linked immunosorbent assay(ELISA)in the diagnosis of systemic lupus erythematosus(SLE),and to determine the optimal detection mode.Methods 92 SLE patients,127 patients with other autoimmune disease and 50 healthy individuals were collected for the study and these subjects were detected for anti-dsDNA antibodies using FFIA,IIF,and ELISA.The sensitivity and specificity of these methods were calculated and the consistence among methods was evaluated by Kappa test.ROC analysis was applied to compare SLE diagnostic accuracy of the result from these methods.Results In SLE group,the positive rates of anti-dsDNA antibodies detected by FFIA,IIF,and ELISA were 44.6%,50.0%and 62.0%,respectively.These rates were all significantly higher than those of the disease control group and healthy control group(P<0.0001).The result of IIF was highly consistent with FFIA and ELISA,with Kappa values of 0.64 and 0.72,respectively.The results of FFIA and ELISA showed moderate consistency,and Kappa value was 0.56.Combined detection of FFIA-IIF or ELISA-IIF by tandem method could improve the sensitivity of SLE diagnosis(59.8%and 67.4%,respectively),while the specificity was acceptable(92.1%and 89.3%,respectively).The coincidence rate of results with diagnosis was increased to 81.0%and 81.8%,respectively.ROC curve analysis showed that FFIA had the highest AUC(0.768),followed by ELISA(0.748),and IIF(0.711).Conclusion The detection of anti-dsDNA antibodies by FFIA,IIF and ELISA has a good consistency and high accuracy in SLE diagnosis.Combined detection of ELISA-IIF or FFIA-IIF(tandem method)can be used as an anti-dsDNA antibody detection mode for SLE diagnosis in clinical practices.