目的 研究抗C1q抗体与系统性红斑狼疮(systemic lupus erythematosus,SLE)疾病活动及肾损害的相关性.方法 使用ELISA法测定93例初诊SLE患者和69例其他风湿性疾病患者及32名健康对照者血清中抗C1q抗体的浓度.同时记录SLE疾病活动指数(systemic lupus erythematosus Disease Activity Index,SLEDAI)、自身抗体和相关实验室指标.结果 血清抗C1q抗体、抗dsDNA抗体、抗核小体抗体(anti-nucleosome antibodies,AnuA),SLE组的阳性率分别为40.9%、62.4%和62.8%.血清抗C1q抗体阳性组患者的肾损害发生率(84.2%)明显高于阴性组(23.6%).狼疮肾炎(lupus nephritis,LN)患者血清抗C1q抗体浓度(55.36±51.96)RU/ml及阳性率(71.1%)显著高于无肾炎表现的狼疮对照组(12.09±14.46)RU/ml,12.5%.无论患者有无肾损害,狼疮疾病活动患者抗C1q抗体浓度(62.46±50.29)RU/ml及阳性率(85.7%)显著高于疾病稳定的狼疮对照组(8.79±6.42)RU/ml,3.9%.而AnuA和抗dsDNA抗体只在伴有狼疮肾损害的疾病活动组即活动LN的阳性率(87.9%与50.0%)显著高于非活动LN对照组(66.7%与33.3%).LN组抗C1q抗体、AnuA、抗dsDNA和抗Sm(Smith)抗体阳性率显著高于非LN组(71.1%与12.5%),(77.8%与47.9%),(57.8%与25.0%),(31.1%与10.4%).SLE疾病活动组抗C1q抗体、AnuA、抗dsDNA阳性率显著高于疾病稳定组(85.7%与3.9%),(88.1%与41.2%),(61.9%与17.6%).活动LN抗C1q抗体、AnuA、抗dsDNA阳性率显著高于非活动LN(93.9%与8.3%),(87.9%与50.0%),(66.7%与33.3%).活动LN组抗C1q抗体、AnuA、抗dsDNA及抗中性粒细胞胞质抗体(ANCA)阳性率显著高于其他SLE组(93.9%与13.1%),(87.9%与48.3%),(66.7%与26.7%),(43.5%与8.5%).结论 血清抗C1q抗体能够反映SLE的疾病活动,并与SLE肾损害相关,是对活动性LN敏感的自身抗体.%Objective To investigate the relation between the presence and concentration of anti-C1q antibodies (Ab) and disease activity and renal involvement in patients with systemic lupus erythematosus (SLE)compared to other connective tissue diseases.Methods Anti-C1q Ab were measured by enzyme-linked immunosorbant assay (ELISA) in 93 patients with SLE.As control groups we included 32 healthy blood donors and 69 diseased controls.Results Anti-C1q Ab were positive in 40.9％, anti-dsDNA Ab in 40.9％ and anti-nucleosome antibodies (AnuA) in 62.8％ of patients with SLE, respectively.The incidence of renal involvement in patients with positive anti-C1q Ab was higher than that in anti-C1q Ab negative group (84.2％ vs 23.6％).Lupus nephritis (LN) patients showed a significantly higher positive rate and serum levels of anti-C1q Ab than non-LN patients [(55.36± 51.96) RU/ml vs (12.09± 14.46) RU/ml], (71.1％vs 12.5％ ).The positive rate and serum levels of anti-C1q Ab was significantly higher in active patients compared with inactive patients [(62.46 ± 50.29) RU/ml vs (8.79 ± 6.42) RU/ml], (85.7％ vs 3.9％).But both AnuA and anti-dsDNA Ab were only significantly higher between patients active nephritis and inactive nephritis (87.9％ vs 50.0％), (66.7％ vs 33.3％).The positive rate of anti-C1q Ab, AnuA, anti-dsDNA Ab and anti-Sm were significantly higher between patients with and without nephritis (71.1％ vs 12.5％),(77.8％ vs 47.9％), (57.8％ vs 25.0％), (31.1％ vs 10.4％).The positive rate of anti-C1q Ab, AnuA and anti-dsDNA Ab were significantly higher between patients with and without disease active (85.7％ vs 3.9％), (88.1％ vs 41.2％), (61.9％ vs 17.6％).The positive rate of anti-C1q Ab, AnuA and anti-dsDNA Ab in patients with active LN were significantly higher than those without active LN (93.9％ vs 8.3％),(87.9％ vs 50.0％), (66.7％ vs 33.3％).The positive rate of anti-C1q Ab, AnuA, anti-dsDNA Ab and antineutrophil cytoplasmic autoantibodies (ANCA) in patients with active LN were significantly higher than those with other SLE (93.9％ vs 13.1％), (87.9％ vs 48.3％), (66.7％ vs 26.7％), (43.5％ vs 8.5％).Conclusion Anti-C1q antibodies are closely related to the pathogenesis of SLE and LN.
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