摘要
目的研究抗核抗体(antinuclear antibody,ANA)荧光核型和抗体谱联合检测在系统性红斑狼疮(systemic lupus erythematosus,SLE)患者诊断中的应用价值。方法对135例SLE患者、96例非SLE风湿性疾病患者与96例健康体检者分别采用间接免疫荧光法(indirect immunofluorometric assay,IIF)和线性免疫印迹法(linearity immunoblotting assay,LIA)检测血清中的ANA荧光核型和ANA谱,分析两种方法联合检测在SLE患者诊断中的应用价值。结果 SLE病人ANA阳性率为99.3%,显著高于疾病对照组(75.0%)和健康对照组(4.5%),差异有统计学意义(P<0.05)。ANA荧光核型以核颗粒型为主(46.7%),其次是核均质型(22.2%),还有少量的胞浆型(13.3%)和均质胞浆混合型(11.1%)。ANA谱分析发现双链DNA(double-strand DNA,dsDNA)抗体、抗低分子量核糖核蛋白(low-molecular ribose nuclear protein,nRNP)抗体、抗核小体(nucleosome,NUC)抗体、Ro-52抗体、SSA抗体、抗核糖体P蛋白(ribosme P protein, RIB)抗体、抗组蛋白(histone, HI)抗体、Smith(Sm)抗体和SSB抗体九种抗体的敏感度均显著高于疾病对照组和健康对照组,两两比较差异均有统计学意义(χ^2=6.60~83.74,均P<0.01)。其中dsDNA抗体的敏感度和特异度分别为57.8%和99.0%,nRNP抗体的敏感度和特异度分别为48.9%和95.8%,NUC抗体的敏感度和特异度分别为40%和99.0%,这三种抗体的敏感度和特异度都比较高。结论 (1) dsDNA抗体、nRNP抗体和NUC抗体可以作为SLE诊断的标志性抗体。(2) ANA荧光核型分析敏感度高而特异度低,ANA谱检测敏感度稍低而特异度高。这两种方法各有其优缺点,在临床工作中应把二者结合起来应用以利于SLE的诊断和治疗。
Objective To investigate the clinical value of combined examination of serum antinuclear(ANA) fluorescence pattern and ANA spectrum on diagnosis of systemic lupus erythematosus(SLE). Methods 135 patients with SLE, 96 patients with non-SLE rheumatic disease and 96 healthy people were examined for ANA fluorescence pattern by indirect immunofluorometric assay(IIF) and ANA spectrum by linearity immunoblotting assay(LIA). The clinical value of combined examination of the two methods on diagnosis of SLE was analyzed. Results The positive rate of ANA in SLE patients was 99.3% which was significantly higher than disease control group(75.0%) and healthy control group(4.5%). The ANA fluorescence pattern included nuclear granular type(46.7%),nuclear homogeneous type(22.2%), cytoplasmic type(13.3%) and homogenous cytoplasmic mixed type(11.1%). It was found by ANA spectrum analysis that the sensitivity of nine types of Ab(including dsDNA Ab, nRNP Ab, NUC Ab, Ro52 Ab, SSA Ab, RIB Ab, HI Ab, Sm Ab and SSB Ab) in SLE patients was significantly higher than disease control group and healthy control group. By Chi-square test, the difference were statistically significant(χ^2=6.60~83.74,all P<0.01). The sensitivity and specificity of dsDNA Ab was 57.8% and 96.3%, that of nRNP Ab was 48.8% and 85.7%, and that of NUC Ab was 40% and 94.7%. The sensitivity and specificity of all the three kinds of antibody in SLE patients was very high. Conclusion ① DsDNA Ab, nRNP Ab and NUC Ab can be used as biological marker for diagnosis of SLE. ② The sensitivity of examination of ANA fluorescence pattern is high while its specificity is very low. The sensitivity of analysis of ANA spectrum is slightly lower but its specificity is very high. Each of the two methods has its advantages and disadvantages, so the two methods should be combined for diagnosis and treatment of SLE.
作者
刘卫霞
庞爱梅
郭绪晓
张恒
LIU Wei-xia;PANG Ai-mei;GUO Xu-xiao;ZHANG Heng(Department of Clinical Laboratory,Affiliated Hospital of Shandong University of TranditionalChinese Medicine,Jinan 250011,China)
出处
《现代检验医学杂志》
CAS
2020年第2期32-34,38,共4页
Journal of Modern Laboratory Medicine
基金
山东省中医药科技发展计划项目(2013-069)。
关键词
系统性红斑狼疮
抗核抗体
荧光核型
抗核抗体谱
systemic lupus erythematosus
antinuclear antibody
fluorescence pattern
ANA spectrum
