系统性红斑狼疮抗核抗体和抗核抗体谱联合检测及其临床意义

Combined detection of antinuclear antibody and antinuclear antibody spectrum and its clinical significance in systemic lupus erythematosus

目的探讨联合检测抗核抗体(ANA)和抗核抗体谱(ANAs)在系统性红斑狼疮(SLE)中的诊断价值及临床意义。方法选取110例SLE患者、88例其他自身免疫病(AID)患者、50例健康体检者,用间接免疫荧光法(IIF)检测血清ANA;用免疫印迹法检测ANAs 15项。结果 110例SLE患者血清中,ANA、抗核糖核蛋白/斯密斯抗体(nRNP/Sm)、抗史密斯抗体(Sm)、抗干燥综合征A抗体(SSA)、抗Ro-52抗体(Ro-52)、抗干燥综合征B抗体(SSB)、抗硬皮病70抗体(Scl-70)、抗PM-Scl抗体(PMScl)、抗细胞浆组酰-tRNA抗体(J0-1)、抗着丝点抗体(CENP B)、抗增值蛋白抗体(PCNA)、抗双链DNA抗体(ds-DNA)、抗核小体抗体(AnuA)、抗组蛋白抗体(AHA)、抗核糖体P蛋白抗体(ARPA)、抗线粒体抗体M2型(AMA M2)的阳性率分别为98.2%、59.1%、39.1%、71.8%、68.2%、21.8%、2.7%、3.6%、0.9%、9.1%、5.5%、44.5%、38.2%、27.3%、38.2%、15.5%,以上16自身抗体在其他AID中的阳性率分别为64.8%、14.8%、0%、37.5%、42.0%、11.4%、9.1%、0%、5.7%、9.1%、1.1%、2.3%、1.1%、1.1%、5.7%、2.3%;ANA对SLE诊断的敏感度最高(98.2%),特异性较低(35.2%),对诊断SLE特异性较高的抗体有抗Sm抗体(100.0%)、抗ds-DNA抗体(97.7%),抗AnuA抗体(99.0%),抗AHA抗体(99.0%),抗ARPA抗体(94.3%),抗PCNA抗体(98.9%)。用IIF检测ANA核型最多的是核颗粒型(43.5%)和疾病对照组(50.9%)比较差异无统计学意义(P>0.05),部分ANA阴性的患者中会有ANAs阳性。结论 SLE患者血清中可检测到多种自身抗体,联合ANA和ANAs检测对SLE的诊断及鉴别诊断有重要临床意义。

Objective To explore the diagnostic value and clinical significance of the combined detection of antinuclear antibody (ANA) and anti-nuclear antibody spectrum (ANAs) in systemic lupus erythematosus (SLE) .Methods 110 patients with SLE ,88 patients with other autoimmune diseases (AID) and 50 individuals with healthy physical examination were selected and detected se-rum ANA by using indirect immunofluorescence (IIF);the Western blot was adopted to detect the 15 items of ANAs .Results A-mong 110 cases of SLE ,the positive rates of serum ANA ,anti-ribonucleoprotein /Smith antibody (nRNP/Sm) ,anti-Smith antibody (Sm) ,anti-Sjogren′s syndrome A antibody (SSA) ,anti-Ro-52 antibody (Ro-52) ,anti-Sjogren′s syndrome B antibody (SSB) ,anti-scleroderma 70 antibody (Scl-70) ,anti-PM-Scl antibody (PM-Scl) ,anti-cytoplasmic group acyl-tRNA antibody (J0-1) ,anti-centro-mere antibodies (CENP B) ,anti-proliferative protein antibody (PCNA ) ,anti-double stranded DNA antibody (ds-DNA ) ,anti-nu-cleosome antibody (AnuA) ,anti-histone antibody (AHA) ,anti-ribosomal P protein antibody (ARPA) and anti-mitochondrial anti-body M2 subtype (AMA M2) were 98 .2% ,59 .1 % ,39 .1 % ,71 .8 % ,68 .2 % ,21 .8 % ,2 .7 % ,3 .6 % ,0 .9% ,9 .1% ,5 .5% , 44 .5% ,38 .2 % ,27 .3 % ,38 .2% and 15 .5% respectively ,the positive rate of above 16 kinds of autoantibody in the orther AID were64.8% ,14.8% ,0% ,37.5% ,42.0% ,11.4% ,9.1% ,0% ,5.7% ,9.1% ,1.1% ,2.3% ,1.1% ,1.1% ,5.7% and2.3% respec-tively ;ANA had the highest diagnostic sensitivity (98 .2% ) and low specificity (35 .2% ) for SLE ,the antibodies with higher speci-ficity in diagnosing SLE were anti-Sm antibody (100 .0% ) ,anti-ds-DNA antibody (97 .7% ) ,anti-AnuA antibody (99 .0% ) ,anti-AHA antibody (99 .0% ) ,anti-ARPA antibody (94 .3% ) and anti-PCNA antibody (98 .9% ) and the disease control group (50 .9% ) .In detecting ANA karyotype by IIF ,the maximum was nuclear particle type (43 .5% ) and the disease control group (50 .9% ) ,no statistically significant difference was found between them (P>0 .05) ,part of the ANA-negative patients have positive ANAs .Conclusion Multiple autoantibodies can be detected in the serum of the SLE patients .The combined detection of ANA and ANAs has important clinical significance for diagnosing and differentially diagnosing SLE .