酶联免疫吸附法与蛋白质免疫印迹法检测抗核小体抗体在SLE诊断中的价值对比

Comparison of the value of enzyme-linked immunosorbent assay and Western blot for the detection of anti-nucleosome antibodies in the diagnosis of SLE

目的比较蛋白质免疫印迹法(WB)、酶联免疫吸附法(ELISA)检测抗核小体抗体(AnuA)在系统性红斑狼疮(SLE)诊断中的价值。方法306例自身免疫疾病患者,根据明确的临床诊断结果将患者分为SLE组(SLE患者,144例)和非SLE组(非SLE患者,162例);选取同期非自身免疫疾病患者100例作为对照组。所有研究对象均采用ELISA及WB检测AnuA。分别统计两种检测方法的AnuA检测结果。比较两种检测方法对AnuA的诊断价值,包括准确度、敏感度、特异度、阳性预测值、阴性预测值,并进行统计学检验,分析两种检测方法的一致性。结果SLE组:ELISA检测AnuA阳性120例、阴性24例,WB检测AnuA阳性109例、阴性35例;非SLE组:ELISA检测AnuA阳性76例、阴性86例,WB检测AnuA阳性71例、阴性91例;对照组:ELISA检测AnuA阳性17例、阴性83例,WB检测AnuA阳性11例、阴性89例;两种检测方法在SLE组、非SLE组和对照组的AnuA检测阳性率比较无统计学意义(P>0.05);但两种检测方法的SLE组患者AnuA阳性率明显高于非SLE组和对照组,且非SLE组患者AnuA阳性率明显高于对照组(P<0.05)。ELISA检测AnuA的敏感度87.4%(180/206)高于WB检测的80.1%(165/206)(P<0.05);两种检测方法的特异度、阳性预测值、阴性预测值、准确度比较无统计学意义(P>0.05)。两种检测方法检测结果的总符合率为90.1%,判断具有较好的一致性(K值=0.516)。结论ELISA及WB检测AnuA在SLE中均具有较高的诊断效能,临床可在AnuA初步检测中运用WB,如有必要可在复检中运用ELISA,有效提高检测阳性率,为临床诊断SLE提供参考。

Objective To compare the value of enzyme-linked immunosorbent assay(ELISA)and Western blot(WB)for the detection of anti-nucleosome antibodies(AnuA)in the diagnosis of systemic lupus erythematosus(SLE).Methods 306 patients with autoimmune diseases were divided into SLE group(SLE patients,144 cases)and non-SLE group(non-SLE patients,162 cases)according to clear clinical diagnosis.100 patients with non-autoimmune diseases in the same period were selected as the control group.All study subjects were tested for AnuA by ELISA and WB.The AnuA detection results of the two detection methods were counted separately.The diagnostic value of the two detection methods for AnuA was compared,including accuracy,sensitivity,specificity,positive predictive value,negative predictive value,and statistical tests were performed to analyze the consistency of the two detection methods.Results In SLE group:120 cases were positive and 24 cases were negative for AnuA by ELISA,109 cases were positive and 35 cases were negative for AnuA by WB;in non-SLE group:76 cases were positive and 86 cases were negative for AnuA by ELISA,71 cases were positive and 91 cases were negative for AnuA by WB;in control group:17 cases were positive and 83 cases were negative for AnuA by ELISA,11 cases were positive and 89 cases were negative for AnuA by WB.There was no significant difference in AnuA positive rate among SLE group,non-SLE group and control group(P>0.05).However,the AnuA positive rate of patients in the SLE group was significantly higher than that of the non-SLE group and the control group for both methods(P<0.05).The sensitivity of ELISA for AnuA was 87.4%(180/206),which was higher than 80.1%(165/206)of WB(P<0.05).The specificity,positive predictive value,negative predictive value and accuracy of the two detection methods were not statistically significant(P>0.05).The total coincidence rate of the two detection methods was 90.1%,and the judgment has a good consistency(K value=0.516).Conclusion ELISA and WB detection of AnuA have high diagnostic efficiency in SLE,and WB can be used in the initial detection of AnuA in clinical practice.If necessary,ELISA can be used in retesting to effectively improve the positive rate of the test and provide reference for clinical diagnosis of SLE.