补体、免疫球蛋白、自身抗体在系统性红斑狼疮辅助诊断中的应用价值

The Application Value of Complement,Immunoglobulin and Autoantibodies in the Auxiliary Diagnosis of Systemic Lupus Erythematosus

目的探讨补体、免疫球蛋白、自身抗体在系统性红斑狼疮辅助诊断中的应用价值。方法选取2018年至2023年于首都医科大学附属北京天坛医院就诊的SLE患者89例作为SLE组,其他自身免疫性疾病患者84例作为非SLE组,同期健康体检者102例作为对照组,分析3组受试者的一般资料(年龄、性别),检测3组受试者免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、补体C3(C3)以及补体C4(C4),定性检测3组受试者自身抗体,定量检测SLE组和非SLE组抗双链DNA抗体(抗dsDNA)。将P<0.05的指标进行ROC曲线分析,并分析其诊断效能。结果SLE组年龄低于非SLE组、SLE组年龄低于对照组,差异有统计学意义(P<0.05);SLE组男性9例,女性80例,非SLE组男性6例,女性78例,对照组男性68例,女性34例,其中SLE组与对照组、非SLE组与对照组性别有差异,差异有统计学意义(P<0.05)。SLE组IgG、IgA高于对照组、SLE组C3、C4低于对照组;非SLE组IgG、IgA、IgM高于对照组、非SLE组C4低于对照组;SLE组IgM、C3、C4低于非SLE组,差异有统计学意义(P<0.05)。SLE组nRNP/Sm、Sm、SS-A、SS-B、PM-SCL、dsDNA、Histone、Rib.P-Prot、AMA-M2、Ro-52、NUC阳性率高于对照组;非SLE组nRNP/Sm、Sm、SS-A、SS-B、CENPB、dsDNA、Histone、Rib.P-Prot、AMA-M2、Ro-52、NUC阳性率高于对照组;SLE组抗dsDNA高于非SLE组;SLE组nRNP/Sm、Sm、CENPB、Histone、Rib.P-Prot、NUC阳性率高于非SLE组,差异有统计学意义(P<0.05)。将IgG、IgA、C3、C4分别进行ROC曲线分析,曲线下的面积AUC分别为0.799、0.629、0.812、0.812,灵敏度分别为78.7%、61.8%、61.8%、65.2%,特异性分别为74.5%、65.7%、91.2%、88.2%。将曲线下的面积AUC>0.8的指标联合检测绘制ROC曲线。C3、C4联合检测曲线下的面积AUC为0.827,灵敏度为74.2%,特异性为83.3%。结论血清补体、免疫球蛋白、自身抗体对SLE辅助诊断有重要意义,其中C3、C4联合检测在SLE辅助诊断中具有较高的应用价值。

Objective To explore the application value of complement,immunoglobulin,and autoantibodies in the auxiliary diagnosis of systemic lupus erythematosus.Methods 89 SLE patients who visited Beijing Tiantan Hospital affiliated with Capital Medical University from 2018 to 2023 were selected as the SLE group,while 84 patients with other types of autoimmune diseases were selected as the non-SLE group,and 102 healthy individuals who underwent physical examinations during the same period were selected as the control group.General information(age,gender)of these three groups was analyzed.Levels of immunoglobulin G(IgG),immunoglobulin A(IgA),immunoglobulin M(IgM),complement C3(C3)and complement C4(C4)were detected in all subjects.We also performed qualitative detection of autoantibodies in all three groups and quantitative detection of anti-double stranded DNA antibodies(anti-dsDNA)in SLE and non-SLE groups.ROC curve of the indicators with P<0.05 were drawn and their diagnostic efficacy were evaluated.Results The age of the SLE group was significantly lower than that of the non-SLE group,and the age of the SLE group was significantly lower than that of the control group(P<0.05);There were 9 males and 80 females in the SLE group,while 6 males and 78 females in the non-SLE group,and 68 males and 34 females in the control group.There were significant gender differences between the SLE group and the control group,as well as between the non-SLE group and the control group(P<0.05).Levels of IgG and IgA in the SLE group were higher than those in the control group,while levels of C3 and C4 in the SLE group were lower than those in the control group;Levels of IgG,IgA,and IgM in the non-SLE group were higher than those in the control group,while the C4 level in the non-SLE group was lower than that in the control group;Levels of IgM,C3,and C4 in the SLE group were lower than those in the non-SLE group,and the differences were statistically significant(P<0.05).The positive rates of nRNP/Sm,Sm,SS-A,SS-B,PM-SCL,dsDNA,Histone,Rib.P-Prot,AMA-M2,Ro-52,and NUC in the SLE group were higher than those in the control group;The positive rates of nRNP/Sm,Sm,SS-A,SS-B,CENPB,dsDNA,Histone,Rib.P-Prot,AMA-M2,Ro-52,and NUC in the non-SLE group were higher than those in the control group;The anti-dsDNA level in the SLE group was higher than that in the non-SLE group;The positive rates of nRNP/Sm,Sm,CENPB,Stone,Rib.P-Prot,and NUC in the SLE group were significantly higher than those in the non-SLE group(P<0.05).AUCs of IgG,IgA,C3 and C4 were 0.799,0.629,0.812,and 0.812,respectively.The sensitivities were 78.7%,61.8%,61.8%,and 65.2%,and the specificities were 74.5%,65.7%,91.2%,and 88.2%,respectively.When drawing ROC curves by jointly detecting indicators with AUC>0.8,AUC of C3 combined with C4 was 0.827,with a sensitivity of 74.2%and a specificity of 83.3%.Conclusion Serum complement,immunoglobulins and autoantibodies are of great significance for the auxiliary diagnosis of SLE,among which the combined detection of C3 and C4 has a high application value.