探讨狼疮带试验对系统性红斑狼疮的临床诊断意义

Diagnostic significance of lupus band test in systemic lupus erythematosus

目的 明确狼疮带试验 (LBT)在系统性红斑狼疮 (SLE)诊断中的作用及LBT与狼疮性肾损害的关系。方法 回顾分析 2 0 0例LBT活检结果。结果 LBT在SLE患者中敏感性、特异性分别为 71%和 82 %。LBT阳性预测值和阴性预测值分别为 91%和 5 0 %。LBT与抗核抗体(ANA) ,抗dsDNA抗体对SLE诊断的敏感性相近 (P >0 0 5 )。SLE伴肾损害组LBT阳性率为 86 % ,显著高于SLE不伴肾损害组 (37% ) (P <0 0 5 )。 2 8例肾活检中 ,LBT阳性组弥漫性增生型狼疮肾炎的发生率为 6 9% ,显著高于LBT阴性组 (17% ) (P <0 0 5 )。LBT免疫成分分析发现IgG及C1q阳性与肾损害密切相关。结论 LBT是SLE辅助诊断的敏感和特异的指标 ,而其较高的阳性预测值提示其在SLE疑难病例诊断中有重要价值。LBT与SLE肾损害的发生密切相关。

Objective To determine the significance of lupus band test (LBT) in diagnosis of systemic lupus erythematosus (SLE) and the relationship of LBT with lupus renal lesions.Methods The results of 200 cases of LBT were retrospectively studied.Results In SLE,the sensitivity and specificity of LBT were 71% and 82% respectively.The positive predictive value was 91% and negative predictive value was 50%.The sensitivity of LBT was not significantly different from that of ANA and anti dsDNA antibody ( P >0 05).Of patients with lupus renal lesions 86% had a positive LBT (+LBT),which was significantly higher than that of patients without renal lesions(37%) ( P <0 05).Renal biopsies were performed in 28 patients with clinical renal lesions,and 69% of patients in +LBT group were testified as diffusive proliferative glomerulonephritis,which was significantly higher than 17% in negative LBT group ( P <0 05).The presence of IgG and/or C1q in a+LBT was associated with a high incidence of clinical renal disease ( P <0 05).Conclusion LBT is a sensitive and specific test for diagnosis of SLE.The high positive predictive value of LBT in SLE suggests that it is valuable in difficult cases of SLE.+LBT has great association with lupus renal lesions.