抗核糖体P蛋白、抗Smith、抗dsDNA、抗核小体及抗组蛋白抗体对系统性红斑狼疮的临床价值探讨  

The clinical value of anti-ribosomal P protein,anti-Smith,anti-dsDNA,anti-nucleosome and anti-histone antibodies for systemic lupus erythematosus

作　　者：王艳萍[1] 邹麟[1] 郭婷 陈曦[1] 史静[1] 陈瀑[1] WANG Yan-ping;ZOU Lin;GUO Ting;CHEN Xi;SHI Jing;CHEN Pu(Department of Laboratory Medicine,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院检验科,重庆400016

出　　处：《现代免疫学》2021年第5期353-360,379,共9页Current Immunology

基　　金：重庆市自然科学基金面上项目(cstc2019jcyj-msxmX0349)。

摘　　要：为比较抗核糖体P蛋白抗体(anti-ribosomal P protein antibody,anti-P)、抗Smith抗体(anti-Smith antibody,anti-Sm)、抗dsDNA抗体(anti-dsDNA)、抗核小体抗体(anti-nucleosome antibody,ANuA)和抗组蛋白抗体(anti-histone antibody,AHA)对系统性红斑狼疮(systemic lupus erythematosus,SLE)的诊断价值,探讨它们与SLE临床特征及疾病活动度的关系,回顾性分析351例SLE患者,200例非SLE自身免疫性疾病患者和100例健康对照者临床资料,计算anti-P、anti-Sm、anti-dsDNA、ANuA和AHA诊断SLE的灵敏度、特异度、阴/阳性预测值及准确度,再进一步比较各抗体阳性组和阴性组SLE患者在临床特征、SLEDAI及C3、C4水平上差异是否显著。结果显示,anti-P、anti-Sm、anti-dsDNA、ANuA和AHA诊断SLE的灵敏度分别为31.9%、20.8%、45.3%、26.5%和18.2%,特异度分别为99.0%、99.3%、99.0%、98.3%和96.0%;5种抗体单阳性者占总阳性数的百分比分别为26.8%、31.5%、20.8%、8.6%和7.8%。其中,anti-P、anti-Sm、anti-dsDNA和AHA阳性组和阴性组在SLE发病年龄上差异有统计学意义(均P<0.05);anti-P阳性组皮肤红斑发生率较高,ANuA阳性组脱发发生率较高,anti-dsDNA、ANuA和AHA阳性组狼疮肾炎(lupus nephritis,LN)的发生率更高,与阴性组相比差异有统计学意义(均P<0.05);anti-P、anti-dsDNA、ANuA和AHA阳性组与阴性组在SLEDAI上差异有统计学意义(有P<0.05);补体C3、C4水平在5个抗体阳性和阴性组间差异均有统计学意义(均P<0.01)。Spearman相关性分析显示SLEDAI与C3、C4水平呈显著负相关(r=-0.395、-0.314)。由此,anti-P、anti-Sm、anti-dsDNA、ANuA和AHA对SLE的诊断具有较高的特异度,但灵敏度较差,联合检测可大大提高SLE的诊断率。anti-P、anti-Sm、anti-dsDNA和AHA阳性患者的发病年龄更小,anti-P阳性与SLE皮肤红斑发生率有关,ANuA阳性与患者脱发可能存在一定关联,而anti-dsDNA、ANuA和AHA阳性时LN的发生率更高。anti-P、anti-dsDNA、ANuA和AHA都与SLE疾病�The aim of this study was to compare the diagnostic value of anti-ribosomal P protein antibody(anti-P),anti-Smith antibody(anti-Sm),anti-dsDNA,anti-nucleosome antibody(ANuA)and anti-histone antibody(AHA)for systemic lupus erythematosus(SLE)as well as to explore their relationship with SLE regarding clinical characteristics and disease activity.A retrospective study was performed with 351 SLE patients,200 autoimmune disease patients other than SLE,and 100 healthy subjects.The sensitivity,specificity,negative/positive predictive value and accuracy of anti-P,anti-Sm,anti-dsDNA,ANuA and AHA in the SLE diagnosis were calculated.Further comparisons were made between the antibody positive and negative groups in clinical features,SLEDAI scores,C3 and C4 levels.The results showed that the sensitivities of anti-P,anti-Sm,anti-dsDNA,ANuA and AHA in SLE diagnosis were 31.9%,20.8%,45.3%,26.5%and 18.2%,and the specificities were 99.0%,99.3%,99.0%,98.3%and 96.0%respectively.The positive rates of the five antibodies alone accounted for 26.8%,31.5%,20.8%,8.6%and 7.8%.There were statistically significant differences in the age of onset between anti-P,anti-Sm,anti-dsDNA,and AHA positive and negative groups(all P<0.05).Compared with the negative group,anti-P positive group had a higher incidence of skin erythema,ANuA positive group was prone to alopecia,the incidence of lupus nephritis(LN)indsDNA positive,ANuA positive or AHA positive groups was higher,and the differences were statistically significant(all P<0.05).The differences of SLEDAI scores between anti-P,anti-dsDNA,ANuA and AHA positive and negative groups were statistically significant(some P<0.05)and the levels of complement C3 and C4 were statistically different between each antibody positive and negative groups(all P<0.01).Spearman correlation analysis showed that there was a significant negative correlation between SLEDAI scores and C3,C4 levels(r=-0.395,-0.314).Above all,anti-P,anti-Sm,anti-dsDNA,ANuA and AHA had high specificity but poor sensitivity in the SLE diagnosi

关 键 词：抗核糖体P蛋白抗体 抗Smith抗体 抗双链DNA抗体 抗核小体抗体 抗组蛋白抗体 系统性红斑狼疮 疾病活动度 

分 类 号：R593.2[医药卫生—内科学]