三种抗体联合检测诊断狼疮肾炎活动性的临床意义  

Clinical significance of combined detection of three autoantibodies in predicting the disease activity of lupus nephritis

作　　者：张雷[1] 孙铀[1] Zhang Lei;Sun You(Department of Rheumatology,the Second Affiliated Hospital of Harbin Medical University,Heilongjiang 150086,China)

机构地区：[1]哈尔滨医科大学附属第二医院风湿科,150086

出　　处：《中华风湿病学杂志》2020年第7期443-446,共4页Chinese Journal of Rheumatology

摘　　要：目的探讨LN患者联合检测抗C1q抗体、抗核小体抗体(AnuA)和结缔组织生长因子(CTGF)的意义和价值。方法收集哈尔滨医科大学附属第二医院2018年6月至12月收治的38例SLE患者,其中15例符合LN诊断标准,23例为非LN患者。选取同期肾内科收治的肾病综合征患者21例肾病综合征患者及其他免疫病患者组24例。比较4组患者自身抗体的水平变化。采用χ^2检验、成组设计的t检验及Logistics回归方法进行数据分析。结果LN组抗C1q抗体、AnuA及CTGF阳性率分别为60%、73%、67%,均高于肾病综合征患者[10%(χ^2=10.51,P<0.05);26%(χ^2=7.03,P<0.05);24%(χ^2=6.61,P<0.01)]与其他免疫病患者组[12%(χ^2=12.17,P<0.05);17%(χ^2=12.32,P<0.05);14%(χ^2=12.59,P<0.05)]。3种抗体C1q、AnuA及CTGF水平与补体C3、C4也呈负相关[(r=-0.24,P<0.05;r=-0.21,P<0.05;r=-0.29,P<0.01)与(r=-0.31,P<0.01;r=-0.19,P<0.05;r=-0.47,P<0.01)],AnuA及抗C1q抗体与IgG、IgM呈正相关[(r=0.51,P<0.01;r=0.34,P<0.01)与(r=0.35,P<0.01;r=0.33,P<0.01)],同时。3种抗体的单独诊断特异度为67.4%、65.9%、83.5%,联合检测的特异度为87.2%。结论抗C1q抗体、AnuA和CTGF对LN的诊断有重要价值,可提高LN的诊断特异性及疾病活动检出率,为早期治疗提供实验室依据。Objective To explore the significance and clinical values of combined detection of anti-C1q antibody(C1q Ab),anti-nucleosome antibody(AnuA)and connective tissue growth factor(CTGF)in lupus nephritis(LN).Methods Thirty-eight patients with systemic lupus erythematosus(SLE)were admitted to the department of rheumatology,the Second Affiliated Hospital of Harbin Medical University from June to December in 2018 and their data were analyzed.The levels of C1q Ab,AnuA and CTGF were detected simultaneously in these patients,15 of whom were with LN and 23 patients without.In contrast,21 patients with nephrotic syndrome admitted to the department of nephrology and 24 patients with other auto immune diseases in the same period were also compared as the control groups.The collected data was analyzed withχ^2 test group t test logistic regression.Results The positive rates of C1q Ab,AnuA and CTGF in the LN group were 60%,73%and 67%,respectively,which were significantly higher than those in the nephrotic syndrome group[10%(χ^2=10.51,P<0.05);26%(χ^2=7.03,P<0.05);24%(χ^2=6.61,P<0.01)]and other immune diseases group[12%(χ^2=12.17,P<0.05);17%(χ^2=12.32,P<0.05);4%(χ^2=12.59,P<0.05)].The three antibody levels were also negatively correlated with complement C3 and C4[(r=-0.24,P<0.05;r=-0.21,P<0.05;r=-0.29,P<0.01)vs(r=-0.31,P<0.01;r=-0.19,P<0.05;r=-0.47,P<0.01)].AnuA and C1q Ab were positively correlated with immunoglobulin(Ig)G and IgM[(r=0.51,P<0.01;r=0.34,P<0.01)vs(r=0.35,P<0.01;r=0.33,P<0.01)].The specificity of the three antibodies was 67.4%,65.9%and 83.5%.The specificity of the combined detection was 87.2%,which was significantly higher than any of the single antibody.Conclusion The three investigated autoantibodies can improve the specificity and diagnosis rate.This is are of significant values for the early diagnosis and treatment of LN.

关 键 词：狼疮肾炎 抗C1Q抗体 抗核小体抗体 结缔组织生长因子 联合检测 

分 类 号：R593.242[医药卫生—内科学] R446.6[医药卫生—临床医学]