抗U1-RNP抗体和抗RNPA/RNP68抗体联合检测在自身免疫性疾病诊断中的价值  

Combined determination of anti-U1-RNP and anti-RNPA/RNP68 antibodies in diagnosis of autoimmune diseases

作　　者：王瑛[1] 张颐豪 季玮[3] 付燕 于雪莹 张慧[1] 胡婷婷[1] 沈薇[2] 满秋红 WANG Ying;ZHANG Yihao;JI Wei;FU Yan;YU Xueying;ZHANG Hui;HU Tingting;SHEN Wei;MAN Qiuhong(Department of Clinical Laboratory,Shanghai Fourth People's Hospital,Tongji University,Shanghai 200434,China;Department of Clinical Laboratory,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 201112,China;Department of Clinical Laboratory,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)

机构地区：[1]同济大学附属上海市第四人民医院检验科,上海200434 [2]上海交通大学医学院附属仁济医院检验科,上海201112 [3]上海中医药大学附属岳阳中西医结合医院检验科,上海200437

出　　处：《检验医学》2024年第11期1066-1071,共6页Laboratory Medicine

基　　金：上海市第四人民医院科研启动专项(sykyqd02101);上海市第四人民医院学科助推计划临床新技术、新方法应用重点项目(SY-XKZT-2021-2002)。

摘　　要：目的探讨抗U1-核糖核蛋白(RNP)抗体和抗RNPA/RNP68抗体在自身免疫性疾病(AID)诊断中的价值。方法选取2021年10月—2024年3月同济大学附属上海市第四人民医院、上海交通大学医学院附属仁济医院AID患者136例[AID组,包括混合性结缔组织病(MCTD)23例、系统性红斑狼疮(SLE)49例、干燥综合征(SS)14例、狼疮性肾炎14例、自身免疫性肝炎(AIH)17例、类风湿性关节炎(RA)19例]和非AID患者136例(非AID组),以及健康体检者100名(正常对照组)。采用流式点阵免疫发光法检测所有研究对象抗RNPA/RNP68抗体,采用免疫印迹法检测抗U1-RNP抗体。采用Kappa检验评估不同方法之间的一致性。采用受试者工作特征(ROC)曲线评估各项指标诊断AID的效能。结果AID组抗U1-RNP抗体和抗RNPA/RNP68抗体阳性率均高于非AID组和正常对照组(P<0.0167),非AID组2种抗体的阳性率亦高于正常对照组(P<0.0167)。各组抗U1-RNP抗体阳性率与抗RNPA/RNP68抗体阳性率差异无统计学意义(P>0.05)。正常对照组2种抗体的一致性较好(Kappa=0.92),AID组的一致性差(Kappa=0.10)。抗U1-RNP抗体、抗RNPA/RNP68抗体联合检测(2种抗体均阳性)诊断AID的曲线下面积(AUC)为0.80,高于单项检测(0.70、0.73)(P<0.01)。对于MCTD、SLE,抗U1-RNP抗体、抗RNPA/RNP68抗体联合检测的AUC分别为0.81、0.75,均高于抗U1-RNP抗体单项检测(AUC分别为0.73、0.70)(P<0.01);且2种抗体联合检测诊断SLE的AUC高于抗RNPA/RNP68抗体单项检测(0.67)(P<0.01)。对于狼疮性肾炎,抗U1-RNP抗体和抗RNPA/RNP68抗体联合检测的AUC为0.52,低于2种抗体单项检测的AUC(0.62、0.69)(P<0.05)。对于SS,抗RNPA/RNP68抗体单项检测的AUC为0.72,高于抗U1-RNP抗体单项检测(0.51)(P<0.05)。抗U1-RNP抗体、抗RNPA/RNP68抗体单项检测和联合检测诊断其他AID的AUC差异均无统计学意义(P>0.05)。结论抗U1-RNP抗体对诊断狼疮性肾炎、RNPA/RNP68抗体对诊断SS具有较高的效能;2种抗体联Objective To investigate the roles of anti-U1-ribonucleoprotein(RNP)antibody and anti-RNPA/RNP68 antibodies in the diagnosis of autoimmune diseases(AID).Methods From October 2021 to March 2024,136 AID patients from Shanghai Fourth People's Hospital of Tongji University and Renji Hospital of Shanghai Jiao Tong University School of Medicine were enrolled[AID group,including 23 cases of mixed connective tissue disease(MCTD),49 cases of systemic lupus erythematosus(SLE),14 cases of Sjögren's syndrome(SS),14 cases of lupus nephritis,17 cases of autoimmune hepatitis(AIH),19 cases of rheumatoid arthritis(RA)],and 136 non-AID patients(non-AID group)and 100 healthy subjects(healthy control group)were enrolled as well.The anti-RNPA/RNP68 antibodies were determined by flow dot matrix immunoluminescence,and anti-U1-RNP antibodies were determined by western blotting.Kappa test was used to evaluate the consistency of different methods.Receiver operating characteristic(ROC)curve was used to evaluate the efficacy of each index in diagnosing AID.Results The positive rates of anti-U1-RNP antibody and anti-RNPA/RNP68 antibody in AID group were higher than those in non-AID group and healthy control group(P<0.0167),and the positive rates of the 2 antibodies in non-AID group were also higher than those in healthy control group(P<0.0167).There was no statistical significance in the positive rate of anti-U1-RNP antibody and anti-RNPA/RNP68 antibody among all the groups(P>0.05).The consistency of the 2 antibodies was better in healthy control group(Kappa=0.92),and it was poor in AID group(Kappa=0.10).The area under curve(AUC)of the combined determination of anti-U1-RNP antibody and anti-RNPA/RNP68 antibody(both positive)was 0.80,which was higher than those of single determinations(0.70,0.73)(P<0.01).For MCTD and SLE,the AUC of anti-U1-RNP antibody and anti-RNPA/RNP68 antibody combined determination were 0.81 and 0.75,respectively,which were higher than those of single determinations of anti-U1-RNP antibody(AUC were 0.73 and 0.70,respect

关 键 词：抗U1-核糖核蛋白抗体 抗RNPA/RNP68抗体 自身免疫性疾病 

分 类 号：R446.62[医药卫生—诊断学]