EB病毒近期感染与系统性红斑狼疮的关联性研究  

Relevance of the Epstein Barr virus infection with systemic lupus erythematosus

作　　者：张小立[1] 冯修高[2] 徐向进[2] 张胜利[2] 林桂英[2] 

机构地区：[1]福建医科大学福总临床医学院 [2]南京军区福州总医院风湿科

出　　处：《中华临床医师杂志（电子版）》2013年第14期88-91,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的检测系统性红斑狼疮(SLE)患者体内EB病毒衣壳抗体(EBV-VCA-IgG、IgA)滴度及病毒DNA载量,探讨SLE患者EB病毒感染情况及病毒再发感染后的激活对SLE总体疾病活动度的影响。方法收集80例SLE患者、118例非SLE的风湿患者、33例正常对照组血标本,运用酶联免疫吸附实验(ELISA)测EB病毒抗体,实时荧光定量PCR测EBV-DNA载量。运用卡方检验比较各组病毒抗体或DNA阳性率差别,非参数检验比较各组病毒抗体滴度、红细胞沉降率、SLE疾病活动度(SLEDAI)等,Spearman相关分析病毒抗体滴度或DNA载量与SLEDAI的关联性。结果 (1)抗体阳性率:SLE组EBV-IgA阳性率显著高于非SLE组及正常对照组(57.5%vs.16.96%,χ2=37.054,P<0.000;57.5%vs.15.15%,χ2=16.92,P<0.000),并与SLE的发病有显著的相关性(r=7.57,P<0.05),但IgG抗体阳性率与对照组相比无差别。抗体滴度:SLE组EBV-IgA及IgG滴度显著高于正常对照组[EBV-IgA:1.11(2.268)vs.0.495(0.856),Z=-2.836,P=0.005;EBV-IgG:5.391(6.038)vs.4.121(5.231),Z=-2.49,P=0.013];(2)SLE组EBV-IgA及IgG滴度与对应的SLEDAI未发现明显的相关性(EBV-IgA:r=0.164,P=0.195;EBV-IgG:r=-0.09,P=0.576)。也未发现EBV-IgA阳性患者在皮疹、关节炎、肝损害、SLEDAI、低补体血症等方面与阴性患者的差别,但红细胞沉降率却明显高于阴性患者[47(82.75)mm/1 h vs.26.5(46.25)mm/1 h,Z=-3.028,P=0.002];(3)80例SLE患者中有42例随访了IgA表型变化,但未发现表型变化对SLEDAI未见明显差异的影响。(4)SLE患者EBV-DNA阳性率也显著高于非SLE风湿病组(27.5%vs.12.8%,χ2=6.712,P<0.05),SLE患者EB病毒DNA载量异常与正常者的SLEDAI比较无统计学意义[分别为15(22)vs.13(20.25),Z=-0.573,P=0.567],并且异常DNA载量值与对应的SLEDAI之间也未见明显的相关性。结论 SLE患者EBV抗体及DNA的高表达,提示EB病毒与SLE密切相关,但是近期感染或再发感染的激活(EBV-IgA或DNA)未影响到SLE总体的疾病活动度变化。Objective We detect EB virus capsid antibody titer and viral DNA load to investigate the relationships of systemic lupus erythematosus and EB virus infection,and expect to find EBV reactivation shoud contributes the flare of SLE or disease origination. Methods Clinical data and peripheral blood of participants were enrolled in this study. EBV infection was diagnosised by ELISA for the EBV specific capsid antibodies IgG, IgA, and Real-time Fluorescence quantitative PCR for viral DNA load.Statistical methods include：chi-square test,non-parametric test,spearman correlation analysis. Results （1）EBV-IgA positive rate in lupus group are higher than the other groups（57.5% vs.16.96%, χ2=37.054, P〈0.000;57.5% vs.15.15%, χ2=16.92, P〈0.000）. EBV-IgA and IgG antibody titer of SLE patients also higher than the control group[EBV-IgA： 1.11（2.268） vs.0.495（0.856）, Z=-2.836, P=0.005; EBV-IgG： 5.391（6.038） vs.4.121（5.231）, Z=-2.49, P=0.013]. （2）EBV-IgA and IgG antibody titer of SLE patients was not correlated with SLEDAI.There was also no significant difference in EBV-IgA positive and negative groups when come to Clinical anomaly index of arthritis, skin rashes, liver damage, low complement hyperlipidemia of SLE（P〉0.05）. But ESR was distincty higher in EBV-IgA positive group compare with negative groups[47（82.75）mm/1 h vs.26.5（46.25）mm/1 h, Z=-3.028, P=0.002]. （3）42 patients who reviewed for EBV-IgA after 3 months was divided into four groups based on antibody phenotypic changes, the compare of SLEDAI before and after in four groups by two related non-parametric test showed no significant difference.（4）EBV-DNA detection rate of SLE patients is higher than non-lupus groups by Real-time Fluorescence quantitative PCR（27.5%vs.12.8%,χ2=6.712, P〈0.05）. The media（Q） of SLEDAI in the EBV-DNA abnormal groups was 15（22）, compared with 13（20.25） in EBV-DNA normal groups（Z=-0.573, P=0.567）.The scatterplot reval that Epstein Barr virus DNA loads of 22 SLE pati

关 键 词：红斑狼疮 系统性 疾病活动指数 病毒衣壳抗体滴度 病毒DNA载量 

分 类 号：R593.241[医药卫生—内科学]