目的 探索抗核小体抗体(ANuA)在系统性红斑狼疮(SLE)患者发病和诊断中的临床意义.方法 采用免疫斑点法,对101例SLE患者、260例其他风湿免疫性疾病患者(包括类风湿关节炎96例,骨关节炎61例,强直性脊柱炎30例等)血清ANuA进行了检测,同时检测抗核抗体(ANA)、抗双链DNA(ds-DNA)抗体、抗可提取核抗原(ENA)抗体等,并结合临床表现及实验室指标进行分析.结果 SLE患者血清ANuA检测的敏感性40.6%(41/101),特异性99.2%(2/260);活动组SLE患者ANuA阳性率(58.1%)明显高于稳定组(26.3%);ANuA阳性的SLE患者红细胞沉降率、ANA滴度、抗ds-DNA量、疾病活动度SLEDAI评分、狼疮肾炎和雷诺现象发生率等明显高于ANuA阴性患者(P<0.05),而补体C3、C4则低于ANuA阴性患者(P<0.01);ANuA检测与抗ds-DNA抗体、抗组蛋白抗体的检测具有一致性,而与其他自身抗体如抗Sm、SSA、心磷脂抗体等无关.结论 AnuA 对SLE的诊断的一定敏感性和高度的特异性,它与SLE疾病活动性和狼疮肾炎的发生等相关.%Objective To explore the role of anti - nucleosome antibodies ( ANuA ) in the pathogenesis and diagnosis of patients with systemic lupus erythematosus ( SLE ).Methods Serum ANuA was measured with immuno - spot assay in 101 SLE patients and 260 patients with other rheumatic diseases including 96 rheumatoid arthritis patients, 61 osteoarthritis patients and 30 ankylosing spondylitis patients.At the same time, anti - nuclear antibodies ( ANA ), anti - ds - DNA antibodies, anti - ENA antibodies were examined and the clinical manifestations were recorded.Clinical significance of ANuA was then analyzed accordingly.Results The sensitivity and specificity of ANuA in SLE were 40.6％ and 99.2％ respectively.The incidence of ANuA in active SLE patients was higher ( 58.1％ ) than in non - active SLE patients ( 26.3％ ).ESR,ANA titer, anti - ds - DNA, SLE Disease Activity Index ( SLEDAI ) score, incidence of lupus nephritis and Raynaud phenomenon were higher in ANuA positive SLE than in ANuA negative SLE ( P ＜ 0.05 ); however, levels of C3 and C4 were on the contrary.ANuA was related to anti - ds - DNA and anti -histone antibodies, but not related to other auto - antibodies such as anti - Sm and anti - SSA.Conclusion ANuA is to some extent sensitive and very specific to the diagnosis of SLE and it is useful to evaluate lupus activity and lupus nephritis.
展开▼
