SLE病人自身抗体检测的循证检验研究  

A study on evidence-based laboratory medicine of the autoantibodies detections for systemic lupus erythematosus

作　　者：万腊根[1] 鞠北华[1] 黄清水[1] 李俊明[1] 

机构地区：[1]南昌大学第一附属医院检验科

出　　处：《实验与检验医学》2009年第5期441-444,共4页Experimental and Laboratory Medicine

摘　　要：目的探讨各种自身抗体单项和联合检测对SLE的诊断效率。方法采用德国欧蒙试剂分别对确诊的SLE病例323例和确诊的非SLE病例246例进行抗核抗体(ANA)和自身抗体7项(包括ds-DNA、nRNP/Sm、Sm、SSA、SSB、SCL-70、J0-1)分别进行单项和联合检测。结果ENA-7项平行联合、ANA+Sm平行联合、ANA+ds-DNA平行联合及ANA单项检测的灵敏度较高分别为88.9%、87.0%、86.7%和84.8%;ds-DNA单项、ANA+ds-DNA序列联合、ds-DNA+nRNP/Sm+Sm序列联合、ANA+Sm序列、Sm单项和nRNP/Sm单项检测用于诊断SLE的特异度最高,分别为99.6%、99.6%、99.5%、99.2%、99.2%和98.0%;ds-DNA单项、ds-DNA+nRNP/Sm+Sm平行联合、ANA+Sm平行联合及ANA+ds-DNA平行联合检测具有较高的+LR,分别为96.7%、79.8%、69.9%和69.7%。结论SLE筛查诊断应首选择ANA,仍有漏诊的可能;SLE的确诊试验应首选自身抗体ds-DNA单项、ANA+ds-DNA序列联合、ds-DNA+nRNP/Sm+Sm序列联合、ANA+Sm序列联合、Sm单项和nRNP/Sm单项检测。Objective To study the single and co-detection of autoantibodies for the diagnosis of SLE. Methods ANA and 7 items of autoantibodies（including ds-DNA, nRNP/Sm, Sm, SSA, SSB, SCL-70, JO-1） were detected from confirmed 323 patients with SLE and 246 no-SLE patients by adopting German EU reagents. Results The sensitivities of parallel of joint ENA-7, ANA＋Sm, ANA＋ds-DNA, and ANA detection were 88.9%, 87.0%, 86.7% and 84.8% respectively; The specificities of single ds-DNA, sequence of joint ANA＋ ds-DNA, ds-DNA ＋ nRNP/Sm＋Sm, ANA＋Sm, single Sm or nRNP/Sm detection were 99.6%, 99.6%, 99.0%, 99.0%, 98.0% and 96.7% respectively; single ds-DNA, parallel of joint ds-DNA＋ nRNP/Sm＋ Sm, ANA＋ ds-DNA, ANA＋Sm were 96.7%, 79.8%, 67.9% and 69.7% respectively. Conclusions The ANA is the first choice for the screening diagnosis of SLE, but it exists the possibility of misdiagnose. The confirmed test should prefer single ds-DNA,sequence of joint ANA＋ ds-DNA, ds-DNA＋nRNP/Sm＋Sm, ANA＋Sm, single Sm and single nRNP/Sm.

关 键 词：系统性红斑狼疮 自身抗体 循证检验医学 

分 类 号：R446.62[医药卫生—诊断学] R593.241[医药卫生—临床医学]