SLE患者IgG4型抗核抗体的检测及其临床意义  

Detection of serum level of anti-nuclear IgG4 in SLE patients and its clinical significance

作　　者：郭林杰 蔡珺 吴静[2] 廖焕金 兰巧芬 彭艳霞 张莉芳 吴平 刘华锋 潘庆军 

机构地区：[1]广东医科大学附属医院肾脏疾病研究所,广东湛江524001 [2]南方医科大学第五附属医院肾内科,广东广州510000

出　　处：《广东医学院学报》2016年第3期300-305,共6页Journal of Guangdong Medical College

基　　金：国家自然科学基金资助(No.81202346);湛江市科技计划资助(No.2015A01026)

摘　　要：目的了解系统性红斑狼疮(Systemic lupus erythematosus,SLE)患者IgG4型抗核抗体检测的临床意义。方法入组SLE患者124例,并以67例类风湿关节炎(RA)患者和70例正常人为对照;酶联免疫吸附试验(ELISA)检测血清IgG4型抗核抗体水平,分析其与临床指标(血肌酐、总胆固醇、血尿素氮、血清白蛋白、血尿酸和24 h尿蛋白等)的相关性,并进一步用抗核抗体谱测定试剂盒(免疫印迹法)检测何种抗原产生IgG4型抗体。结果 SLE、RA患者的血清IgG4型抗核抗体阳性率分别为85.5%、56.7%,均显著高于正常人的18.6%(P<0.01)。SLE患者血清中IgG4型抗核抗体水平与血清C3、血清白蛋白及血清总IgG4水平分别呈正相关(r=0.55、0.42、0.52,均P<0.05);与24 h尿蛋白定量呈负相关(r=-0.47,P<0.05)。抗原特异性IgG4型抗体以组蛋白、核小体、dsDNA、Ro-52、SS-A、Sm和nRNP为主,而在15种自身抗原中,在IgG型抗核抗体阳性的SLE患者中,普遍存在IgG4亚型抗体。结论在抗核抗体阳性的SLE患者中普遍存在广谱、自身方应性的IgG4亚型抗体;IgG4型抗核抗体在SLE的发病中可能起保护作用,有望为SLE的防治提供新的策略。Objective To investigate serum levels of anti-nuclear IgG4 in the patients with systemic lupus erythematosus （SLE） and its clinical significance. Methods A total of 124 cases with SLE were enrolled, and 67 cases with 67 rheumatoid arthritis （RA） patients and 70 healthy persons served as control. Serum level of anti-nuclear IgG4 was measured using Enzyme-linked immune sorbent assay （ELISA）. Additionally, the correlations between serum level of anti-nuclear lgG4 and several clinical parameters in SLE patients （serum creatinine, total cholesterol, blood urea nitrogen, serum albumin, blood uric acid and 24h urinary protein） were analyzed. Finally, the antigen generating anti-nuclear IgG4 was detected with immuneblotting assays kit. Results The positive rate of serum IgG4 in the patients with SLE （85.5%） and RA （56.7%） was significantly higher in that in healthy persons （18.6%）. Serum IgG4 level in the patients with SLE was positively correlated with serum C3, serum albumin and total serum IgG4 level, respectively （r=0.55, 0.42, 0.52, P〈0.05 for all）; and negatively correlated with 24 h albumin （r=-0.47, P〈0.05）. Immune-blotting assay showed that anti-nuclear IgG4 mainly included histone, nucleosome, dsDNA, Ro-52, SS-A, Sm and nRNP antibody, and IgG4 subtype antibody commonly exists in SLE patients with anti-nuclear IgG positive. Conclusion The IgG4 subtype antibody commonly exists in SLE patients with anti- nuclear antibody positive; and anti-nuclear IgG4 may play a protective role in the onset of SLE and may be expected to provide new therapeutic strategies for SLE.

关 键 词：系统性红斑狼疮 IGG4 抗核抗体 补体 

分 类 号：R593.24[医药卫生—内科学]