抗SmD1抗体在系统性红斑狼疮患者中的临床意义及其与临床表现的关系  

Value of Anti-SmD1 Antibody in Patients with Systemic Lupus Erythematosus(SLE)and Its Relationship with Clinical Features

作　　者：王利民[1,2] 胡朝军[1] 张蜀澜[1] 李梦涛[1] 曾小峰[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院风湿免疫科风湿免疫病学教育部重点实验室,北京100730 [2]浙江大学金华医院检验科,浙江金华321000

出　　处：《中华临床免疫和变态反应杂志》2017年第2期106-111,共6页Chinese Journal of Allergy & Clinical Immunology

基　　金：国家863计划重大项目(2011AA02A104);国家自然科学基金(81373189;81302610);北京协和医学院"协和青年基金"(3332015091)

摘　　要：目的研究抗SmD1抗体在系统性红斑狼疮(systemic lupus erythematosus,SLE)诊断中的临床意义及与疾病活动性和临床表现的关系。方法采用酶联免疫吸附测定法(enzyme-linked immunosorbent assay,ELISA)检测150例SLE患者和216例非SLE对照血清的抗SmD1抗体、抗Sm抗体和抗ds-DNA抗体,非SLE包括20例强直性脊柱炎(ankylosing spondylitis,AS)、40例类风湿性关节炎(rheumatoid arthritis,RA)、33例干燥综合征(Sjogren's syndrome,SS)、53例系统性硬化症(systemic sclerosis,SSc)患者和健康体检者70例。分析抗SmD1抗体在SLE中的诊断敏感度和特异度及其与疾病活动度和临床症状的关系。结果抗SmD1抗体在150例SLE患者中的敏感度为66.00%,高于抗Sm抗体(36.00%,χ2=27.01,P=0.000)和抗ds-DNA抗体(51.33%,χ2=6.65,P=0.010),抗SmD1抗体、抗Sm抗体和抗ds-DNA抗体的特异度分别为87.50%、98.15%和98.61%。抗SmD1抗体浓度与SLE患者颊部红斑、脱发等症状相关(P<0.05),与肾脏受累、关节炎、口腔溃疡、浆膜炎、血液系统受累、神经系统受累、间质性肺炎、肺动脉高压等症状不相关(P>0.05)。在抗ds-DNA抗体阴性的SLE中抗SmD1抗体阳性率为22.67%。结论抗SmD1抗体在SLE疾病诊断中敏感度显著高于抗Sm抗体和抗ds-DNA抗体,该抗体对SLE的诊断,特别是抗ds-DNA抗体阴性SLE的诊断具有重要临床意义。Objective To study the clinical significance of anti-SmD1 antibody in the diagnosis of systemic lupus erythematosus （SLE） and its relationship with disease activity and clinical features. Methods ELISA was used to detect the anti-SmD1 antibody, anti-Sm antibody, and anti-dsDNA anti- body in the sera from 150 patients with SLE and 216 patients without SLE （ including 20 patients with an- kylosing spondylitis （AS）, 40 patients with rheumatoid arthritis （RA）, 33 patients with Sjogren syn-drome （SS）, 53 patients with systemic sclerosis （SSc） and 70 healthy subjects. The sensitivity and spe- cificity of anti-SmD1 antibody in SLE and its relationship with disease activity and clinical features were analyzed. Results The sensitivity of anti-SmD1 antibody in 150 patients with SLE was 66. 00%, which was higher than that of anti-Sm antibody （36. 00%, X^2 = 27.01, P= 0. 000） and anti-dsDNA antibody （ 51.33%, X^2 = 6.65, P = 0. 010）. The specificity of anti-SmD 1 antibody, anti-Sm antibody, and anti-ds- DNA antibody was 87.50%, 98. 15%, and 98.61%, respectively. The presence of anti- SmD1 antibodies was significantly associated with malar rash, non-scarring alopecia （P〈0. 05）. There was no significant association between the positivity of anti-SmD1 antibodies and other clinical characteristics of SLE such as renal disorder, arthritis, oral ulcers, serositis, hematological disorder, neurologic disorder, interstitial lung disease, and pulmonary arterial hypertension （P〉0. 05）. The positive rate of anti-SmD1 antibody in SLE patients without anti-dsDNA antibody was 22.67%. Conclusion The anti-SmD1 antibody is more sensitive than the anti-Sm antibody and anti-dsDNA antibody for the diagnosis of SLE disease, which is of great clinical significance in the diagnosis of SLE, especially in the diagnosis of SLE with negative anti- dsDNA antibody.

关 键 词：红斑狼疮 系统性 抗SmDl抗体 抗SM抗体 抗DS-DNA抗体 

分 类 号：R593.241[医药卫生—内科学]