264例系统性红斑狼疮患者抗磷脂抗体与抗核抗体、抗双链DNA抗体关系的研究

A Study of the Relationship Between Anti-Phospholipid Antibody with Anti-Nuclear Antibody and Anti-dsDNA in 264 Cases of Systemic Lupus Erythematosus Patients

目的分析系统性红斑狼疮(SLE)患者抗磷脂抗体(APL)特征及其与抗核抗体(ANA)核型、抗双链DNA抗体(anti-dsDNA)之间的关系,为SLE患者系统性治疗提供参考。方法选取2018年1月至2021年12月就诊于首都医科大学附属北京同仁医院的SLE患者264例,回顾性分析患者APL[狼疮抗凝物(LA)、抗心磷脂抗体(ACA)、和抗β_(2)糖蛋白I抗体(anti-β_(2) GPI)]与ANA核型特征、anti-dsDNA的关系。结果264例患者中164例(62.12%)LA阳性、22例(8.33%)ACA阳性、38例(14.39%)anti-β_(2) GPI阳性、260例(98.48%)ANA阳性和136例(51.52%)anti-dsDNA阳性。在164例LA阳性的SLE患者中,LA弱阳性表达92例(56.10%),LA阳性表达52例(31.71%),LA强阳性表达20例(12.19%)。ACA、anti-β_(2) GPI和LA均阳性16例。260例ANA阳性的SLE患者中,胞核均质型48例(18.46%),胞核斑点型70例(26.92%)和胞核混合型142例(54.62%)。260例ANA阳性SLE患者中,不同ANA核型LA阳性率不同,胞核混合型阳性率最高约为73.24%;其次是胞核均质型为58.33%,而胞核斑点型则以LA阴性为主。Anti-dsDNA阳性的SLE患者中约有11.76%患者ACA为阳性,anti-dsDNA阴性的SLE患者中约有95.31%患者ACA为阴性,ACA与anti-dsDNA阳性率的差异有统计学显著性(P=0.038)。Anti-dsDNA阳性的SLE患者中约有72.06%患者LA为阳性,anti-dsDNA阴性的SLE患者中约有48.44%患者LA为阴性,LA与anti-dsDNA阳性率的差异有统计学显著性(P=0.004)。结论SLE患者的ANA核型多表现为胞核混合型,LA表达多为阳性,且LA以弱阳性表达为主;不同ANA核型中LA阳性率不同,ACA和LA与anti-dsDNA阳性率有显著性差异。APL、ANA和anti-dsDNA检测对SLE患者系统治疗有积极的意义。

Objective To conduct a study of the relationship between anti-phospholipid antibody with anti-nuclear antibody and anti-dsDNA in patients with systemic lupus erythematosus in order to assist SLE systematic treatment.Methods 264 cases of SLE patients in Beijing Tongren Hospital,Capital Medical University from January,2018 to December,2021 were selected.We retrospectively analyzed the relationship between APL(LA,ACA and Anti-β_(2)GPI)with ANA patterns and anti-dsDNA.Results In 264 patients,164(62.12%)patients were positive for LA,22(8.33%)patients were positive for ACA,38(14.39%)patients were positive for anti-β_(2) GPI,260(98.48%)patients were positive for ANA and 136(51.52%)patients were positive for anti-dsDNA.In 164 LA positive patients,92(56.10%)patients were weakly positive,52(31.71%)patients were positive and 20(12.19%)patients were strong positive.16 patients were positive for LA,ACA and anti-β_(2) GPI.There were 48 patients(18.46%)of homogeneous,70 patients(26.92%)of speckled and 142 patients(54.62%)of mixed patterns in 260 ANA positive patients.LA positive rates were different among different ANA patterns in 260 ANA positive patients.The positive rate(73.24%)in mixed patterns was the highest,followed by homogeneous(58.33%),while the speckled was mainly LA negative.16(11.76%)patients were ACA positive in anti-dsDNA positive SLE patients,while 122(95.31%)patients were ACA negative in anti-dsDNA negative SLE patients.The difference was statistically significant(P=0.038)between ACA and anti-dsDNA.98(72.06%)patients were LA positive in anti-dsDNA positive SLE patients,while 62(48.44%)patients were LA negative in anti-dsDNA negative SLE patients.The difference was statistically significant(P=0.004)between LA and anti-dsDNA.Conclusion ANA patterns are mostly mixed patterns in SLE patients,LA is mostly positive,and mainly LA are weakly positive.LA positive rates are different among different ANA patterns,and there are significant differences in the positive rates of ACA,La and anti-dsDNA.The detection of APL,ANA and anti-dsDNA has a positive significance for the follow-up systematic treatment of SLE patients.