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目的探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)患者血清中抗C1q抗体及抗ENA抗体与SLE疾病活动状态和肾脏受累的关系,揭示抗C1q抗体、抗ENA抗体在疾病诊断及评判中的临床价值。方法将来自本院123例SLE患者按疾病活动状态以及是否满足狼疮性肾炎(lupus nephritis,LN)诊断条件分为LN活动组、非LN活动组、LN稳定组和非LN稳定组。患者24 h内收集血、尿标本,分别用ELISA法检测抗C1q抗体;斑点印迹法检测抗ENA抗体;干式化学法检测尿蛋白;用全自动生化分析仪检测血β2微球蛋白(β2-MG)和肌酐(CREA)。结果β2-MG阳性率:LN活动组与非LN活动组(88.6%vs 59.4%)、LN稳定组与非LN稳定组(66.1%vs 47.4%)比较差异有统计学意义(P<0.05,P<0.01);CREA阳性率:LN稳定组与非LN稳定组相比差异有显著性(27.8%vs 0.0%,P<0.01);尿蛋白“++++”阳性率:LN活动组(42.9%)与非LN活动组(12.5%)、非LN稳定组(2.6%)比较差异有统计学意义(P<0.05,P<0.01);抗C1q抗体阳性率:LN活动组与非LN稳定组相比差异有统计学意义(68.6%vs 36.8%,P<0.05)。抗C1q抗体阳性与阴性组间尿蛋白“++++”、“+”阳性率比较差异有显著性(26.2%vs 11.3%,14.8%vs 38.7%,P<0.05)。结论 SLE患者肾脏损害常发生于疾病活动期,抗C1q抗体和部分抗ENA抗体可能是加重肾脏损害的因素。实验室监测抗C1q抗体及β2-MG的水平对预测SLE患者肾脏损害有积极指导意义。
Objective To investigate the relationship between anti-C1q antibody and anti-ENA antibody in sera of patients with systemic lupus erythematosus (SLE) and SLE disease activity status and renal involvement, and to reveal the clinical significance of anti-C1q antibody and anti-ENA antibody in the diagnosis and evaluation of disease value. Methods 123 cases of SLE from our hospital were divided into LN group, non-LN group, LN group and non-LN group according to the disease activity status and the lupus nephritis (LN) diagnostic criteria. The blood and urine samples were collected within 24 hours. The anti-C1q antibodies were detected by ELISA. The anti-ENA antibodies were detected by dot blot assay. The urinary protein was detected by dry chemistry. The levels of β2- MG) and creatinine (CREA). Results The positive rate of β2-MG was significantly higher in LN active group than in non-LN active group (88.6% vs 59.4%, 66.1% vs 47.4%, LN stable group and non-LN stable group, P <0.05, P <0.01). The positive rate of CREA: The difference between LN stable group and non-LN stable group was significant (27.8% vs 0.0%, P <0.01). The positive rate of urinary protein “++++” (42.9%) were significantly higher than those in non LN group (12.5%) and non LN group (2.6%) (P <0.05, P <0.01) The difference between the stable group was statistically significant (68.6% vs 36.8%, P <0.05). The positive rates of urinary protein “++++ ” and "+ in positive and negative groups of anti-C1q antibody were significant difference (26.2% vs 11.3%, 14.8% vs 38.7%, P <0.05). Conclusion Kidney damage in patients with SLE often occurs in the active stage of disease. Anti-C1q antibody and some anti-ENA antibodies may be the factors that aggravate renal damage. Laboratory monitoring of anti-C1q antibodies and β2-MG levels in the prediction of kidney damage in patients with SLE has a positive guiding significance.