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目的:比较间接免疫荧光法(IIF)、免疫印迹法(WB)和酶联免疫吸附法(ELISA)检测抗双链DNA(ds-DNA)抗体。方法:选取在该院就诊的360例系统性红斑狼疮(SLE)患者,360例疾病对照组及30例健康体检者(健康对照组),分别采用上述3种检测方法检测抗ds-DNA抗体,并对3种方法检测结果采用Fisher确切概率法进行分析,对其不一致性和一致性分别进行Mc Nemar配对χ2检验和Kappa检验。结果:SLE组中ELISA法阳性检出率最高(78.1%),其次为WB法(53.3%),IIF法阳性检出率最低(46.9%),但均高于疾病对照组和健康对照组(P<0.01)。特异度和阳性预测值最高的是IIF法,灵敏度和阴性预测值最高的是ELISA法,其次是WB法及IIF法。ELISA法灵敏度为78.1%,特异度为81.0%。3种方法检测结果差异有统计学意义(P<0.01)。一致性Kappa检验示WB法与IIF法,WB法与ELISA法一致性一般,Kappa值均为0.66;IIF法与ELISA法一致性不如前两者,Kappa值为0.50。结论:ELISA法是检测抗ds-DNA抗体的首选方法。IIF法特异度最高,检测抗ds-DNA抗体与SLE临床诊断的符合率很高,而WB法从灵敏度和特异度都没有突出的优势。ELISA法与IIF法两者联合检测对SLE患者的诊断和病情动态检测有重要意义。
OBJECTIVE: To compare anti-double-stranded DNA (ds-DNA) antibodies by indirect immunofluorescence assay (IFF), Western blotting (WB) and enzyme-linked immunosorbent assay (ELISA) Methods: 360 patients with systemic lupus erythematosus (SLE), 360 patients with disease control group and 30 healthy controls (control group) were enrolled in the study. Anti-dsDNA antibodies were detected by the above three methods, Fisher’s exact test was used to analyze the results of the three methods. McNemar’s pairedχ2 test and Kappa test were used to analyze the inconsistency and consistency. Results: The positive rate of ELISA in SLE group was the highest (78.1%), followed by WB method (53.3%), the lowest in IIF method (46.9%), but higher than that in control group and healthy control group P <0.01). IIF was the highest specificity and positive predictive value, ELISA was the highest sensitivity and negative predictive value, followed by WB and IIF. ELISA sensitivity was 78.1%, specificity was 81.0%. There was significant difference between the three methods (P <0.01). Consistency Kappa test showed that WB method and IIF method, WB method and ELISA method consistency, Kappa value was 0.66; IIF method and ELISA method consistency as the first two, Kappa value of 0.50. Conclusion: ELISA method is the first choice to detect anti-ds-DNA antibody. IIF method has the highest specificity, the detection rate of anti-ds-DNA antibody and SLE clinical diagnosis is very high, but the sensitivity and specificity of WB method have no outstanding advantages. ELISA and IIF combined detection of SLE patients with the diagnosis and disease dynamic detection of great significance.