检测抗双链DNA抗体的3种方法比较研究  

Comparison of the three methods for the detection of anti-double-stranded DNA antibodies

作　　者：张晓军[1] 朱晓敏 吴云娟[1] 陆凤云 张缪佳[1] 

机构地区：[1]南京医科大学第一附属医院风湿免疫科,江苏南京210029 [2]南京医科大学第一附属医院临床实验研究室,江苏南京210029

出　　处：《临床皮肤科杂志》2015年第10期615-617,共3页Journal of Clinical Dermatology

摘　　要：目的:比较间接免疫荧光法(IIF)、免疫印迹法(WB)和酶联免疫吸附法(ELISA)检测抗双链DNA(ds-DNA)抗体。方法:选取在该院就诊的360例系统性红斑狼疮(SLE)患者,360例疾病对照组及30例健康体检者(健康对照组),分别采用上述3种检测方法检测抗ds-DNA抗体,并对3种方法检测结果采用Fisher确切概率法进行分析,对其不一致性和一致性分别进行Mc Nemar配对χ2检验和Kappa检验。结果:SLE组中ELISA法阳性检出率最高(78.1%),其次为WB法(53.3%),IIF法阳性检出率最低(46.9%),但均高于疾病对照组和健康对照组(P<0.01)。特异度和阳性预测值最高的是IIF法,灵敏度和阴性预测值最高的是ELISA法,其次是WB法及IIF法。ELISA法灵敏度为78.1%,特异度为81.0%。3种方法检测结果差异有统计学意义(P<0.01)。一致性Kappa检验示WB法与IIF法,WB法与ELISA法一致性一般,Kappa值均为0.66;IIF法与ELISA法一致性不如前两者,Kappa值为0.50。结论:ELISA法是检测抗ds-DNA抗体的首选方法。IIF法特异度最高,检测抗ds-DNA抗体与SLE临床诊断的符合率很高,而WB法从灵敏度和特异度都没有突出的优势。ELISA法与IIF法两者联合检测对SLE患者的诊断和病情动态检测有重要意义。Objective： The anti-double-stranded DNA（ds-DNA） antibodies were detected by indirect immunofluorescence （IIF）, Western blotting（WB） and enzyme-linked immunosorbent assay（ELISA）. Methods： Three-hundred SLE patients, 300 patients with other diseases（disease control group） and 30 healthy individuals（healthy control group） were collected to detect anti-ds-DNA antibodies using the above three methods. The results were subjected to Fisher exact test, performance analysis as well as MeNemar test and Kappa test. Results： The positive rates of the 3 methods in the SLE group were all signifi- cantly higher than those of the disease control group and healthy control group（P〈O.O1）, ELISA was the highest（78.1%）, fol- lowed by WB（53.3%）, and the positive rate of IIF was the lowest（46.9%）. The specificity and positive predictive value of IIF were the highest, while the sensitivity and the negative predictive value of ELISA were the highest, followed by WB and IIF. The sensitivity of ELISA was 78.1% and specificity was 81.0%. The disagreement between the three methods was statis- tically significant （P〈O.O1）. Kappa test showed that the result of WB was well consistent with that of IIF assay and ELISA assay, with the Kappa value of 0.66, and the consistency between IIF assay and ELISA assay was not as good with a Kappa value of 0.50. Conclusions： ELISA is the first choice for the detection of anti-ds-DNA antibodies, whereas the specificity of IIF is the highest. Detection of anti-ds-DNA antibodies by IIF is consistent well in the diagnosis of SLE. WB demonstrates no advantage in the sensitivity or specificity as compared with the other two methods. Therefore, the combined use of ELISA and IIF is of significant diagnostic value, and may be used to the dynamic monitoring and evaluating the prognosis of SLE.

关 键 词：间接免疫荧光法 免疫印迹法 酶联免疫吸附法 系统性红斑狼疮 抗双链DNA抗体 

分 类 号：R758.73[医药卫生—皮肤病学与性病学]