抗ENO1抗体与狼疮性视网膜病变的相关性

Relationship between anti-ENO1 antibody and systemic lupus erythematosus patients with retinopathy

目的:研究抗α烯醇化酶抗体[抗ENO1(enolase 1)抗体]水平与狼疮性视网膜病变及系统性红斑狼疮(systemic lupus erythematosus,SLE)活动性的相关性。方法:选择2017年4月至2022年5月北京大学人民医院风湿免疫科住院的活动性SLE患者,分为SLE合并和不合并狼疮性视网膜病变两组,同时以年龄匹配且不合并视网膜病变的健康志愿者作为阴性对照组,应用酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)检测各组血清中抗ENO1抗体水平和阳性率,同时收集前两组SLE患者活动性相关的临床特征和实验室结果,分析抗ENO1抗体水平与其他SLE临床资料与实验室指标之间的相关性。结果:SLE合并狼疮性视网膜病变患者眼底出现了多种视网膜病变,占比排名前三的是视网膜出血(14/32,43.75%)、棉絮斑(8/32,25.00%)和视网膜静脉阻塞(3/32,9.38%)。在32例SLE合并狼疮性视网膜病变患者中,有13例(40.63%)出现了两种及以上的视网膜病变。SLE合并狼疮性视网膜病变患者的血清抗ENO1抗体水平和阳性率显著高于不合并狼疮性视网膜病变组(P<0.05),狼疮性视网膜病变患者具有更高的SLE疾病活动度评分(P<0.001)。将SLE患者分为抗ENO1抗体阳性和阴性两组进行研究发现,在临床表现上,抗ENO1抗体阳性与发热和尿潜血有关的可能性大(P=0.011,P=0.042);在实验室指标上,与抗ENO1抗体阴性的SLE患者相比,抗ENO1抗体阳性的SLE患者具有更高的红细胞沉降率(erythrocyte sedimentation rate,ESR)、免疫球蛋白G(immunoglobulin G,IgG)和血小板计数(blood platelet count,PLT,P<0.01),此外,抗ENO1抗体阳性患者还具有更高的免疫球蛋白A(immunoglobulin A,IgA,P<0.05)。结论:合并狼疮性视网膜病变的SLE患者血清中抗ENO1抗体的水平和阳性率明显升高,且具有更高的疾病活动性。

Objective:To build bridges between anti-αenolase antibody(anti-enolase 1 antibody,anti-ENO1 antibody)and common clinical and laboratory characteristics of systemic lupus erythematosus(SLE)and to analyze the role of anti-ENO1 antibody in the evaluation of SLE disease activity.Methods:The SLE patients with retinopathy and without retinopathy were enrolled in the study,as well as healthy individuals whose gender and age matched with those of the SLE patients.Serum anti-ENO1 antibodies were measured using enzyme-linked immunosorbent assay(ELISA),presenting as intra-group positive rate and arbitrary units(AU)value.Clinical and laboratory data were obtained from medical records.Results:The SLE retinopathy patients represented various fundus abnormalities.Ranked by percentage,the top three retinopathies were retinal hemorrhage(14/32,43.75%),cotton-wool spots(8/32,25.00%)and retinal vein occlusion(3/32,9.38%).Among the 32 SLE retinopathy patients,13(40.63%)suffered from two or more fundus abnormalities.The positive rate and AU value of the SLE patients were higher than of the SLE patients without retinopathy(68.75%vs.46.00%,P=0.043;16.11%±10.35%vs.12.06%±6.47%,P=0.045).Besides,the positive rate and AU value of the two SLE groups were both significantly higher than those of the healthy control group(P<0.001).Compared with the SLE-without-retinopathy group,the systemic lupus erythematosus disease activity index(SLEDAI)-2000 of the SLE retinopathy patients were significantly higher than those of the SLE patients without retinopathy(17.41±4.25 vs.9.48±5.35,P<0.001).Dividing all the SLE patients into an anti-ENO1-positive group and an anti-ENO1-negative group,we found that anti-ENO1-positive was more likely to be correlated to developing fever and positive result of urine occult blood(P=0.011,P=0.042).Comparing with the patients with negative anti-ENO1 antibodies,the patients with positive anti-ENO1 antibodies had significantly higher erythrocyte sedimentation rate(ESR)[the median(range)was 29.50(1.52-110.00)mg/L vs.12.00(4.00-101.00)mg/L,P=0.001],higher immunoglobulin G(IgG)[the median(range)was 14.30(4.02-37.80)g/L vs.10.46(2.50-25.73)g/L,P=0.0003],and higher blood platelet count(PLT)[(205.87×10^(9)±67.98×10^(9))/L vs.(164.57×10^(9)±69.57×10^(9))/L,P=0.008],as well as higher immunoglobulin A(IgA)[the median(range)was 2.85(0.07-27.00)g/L vs.2.05(0.42-4.36)g/L,P=0.014].Conclusion:The positive rate and AU value of anti-ENO1 antibody suggested higher SLE disease activity and they were elevated in SLE and SLE retinopathy.