论文部分内容阅读
目的探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)患者抗核抗体谱(antinuclear antibody spectrum,ANAs)与抗中性粒细胞胞浆抗体(antineutrophil cytoplasmic antibody,ANCA)联合检测的临床意义。方法采用间接免疫荧光法(IIF)和免疫印迹法(Western blot)检测120例SLE组患者、60例疾病对照组患者和20位健康人的ANCA和ANAs。用ELISA法检测验证ANCA阳性率,用SLE活动指数(SLEDAI)判断SLE活动性,分析ANCA、SLEDAI和ANAS之间的关系。结果在120例SLE患者中IIF法检测ANCA的阳性率为27.5(33/120),且均为核周型(perinuclear ANCA,pANCA)。用ELISA法验证全部ANCA阳性患者血清,阳性率为81.8(27/33),且均为髓过氧化物酶(myeloperoxidase,MPO)即为pANCA。ANCA阳性组SLEDAI评分>10分者(即SLE活动期)占81.4%与ANCA阴性组(36.5%)相比差异有显著性意义(P<0.01)。ANCA阳性组在血沉升高,补体C3、C4降低,肾脏损害、肺损害、关节肿痛等方面与ANCA阴性组比较差异具有显著性(P<0.01)。ANCA阳性率与抗ds-DNA抗体、抗Sm抗体、抗核小体抗体(AnuA)及抗核糖体P蛋白抗体(ARPA)阳性率呈正相关。结论联合检测ANCA和SLE的各项特异性自身抗体可能对SLE患者的早期发现、治疗、病情活动判断具有重要的意义。
Objective To investigate the clinical significance of combined detection of antinuclear antibody spectrum (ANAs) and antineutrophil cytoplasmic antibody (ANCA) in patients with systemic lupus erythematosus (SLE). Methods ANCA and ANAs in 120 patients with SLE, 60 patients with disease control and 20 healthy people were detected by indirect immunofluorescence (IIF) and Western blot. The ANCA positive rate was detected by ELISA, the activity of SLE was evaluated by SLE activity index (SLEDAI), and the relationship between ANCA, SLEDAI and ANAS was analyzed. Results The positive rate of ANCA detected by IIF in 120 SLE patients was 27.5 (33/120), and both were perinuclear ANCA (pANCA). The positive rate of all ANCA-positive patients was 81.8 (27/33) by ELISA, and pANCA was myeloperoxidase (MPO). ANCA positive group SLEDAI score> 10 points (ie SLE active phase) accounted for 81.4% and ANCA negative group (36.5%) compared with the difference was significant (P <0.01). ANCA positive group was significantly higher than ANCA negative group (P <0.01) in erythrocyte sedimentation rate, decreased C3, C4, renal damage, lung damage, joint swelling and pain. The positive rate of ANCA was positively correlated with the positive rate of anti-dsDNA antibody, anti-Sm antibody, AnuA antibody and anti-ribosomal P protein antibody (ARPA). Conclusions The combined detection of ANCA and SLE specific autoantibodies may be of great significance for the early detection, treatment and assessment of disease activity in SLE patients.