系统性红斑狼疮中的抗C1q抗体和抗内皮细胞抗体——与疾病活动度及肾脏受累的关系

Anti-C1q antibodies and antiendothelial cell antibodies in systemic lupus erythematosus - relationship with disease activity and renal involvement.

作者信息

Oelzner P, Deliyska B, Fünfstück R, Hein G, Herrmann D, Stein G

机构信息

Friedrich-Schiller-University of Jena, Jena, Germany.

出版信息

Clin Rheumatol. 2003 Oct;22(4-5):271-8. doi: 10.1007/s10067-003-0724-3.

DOI:10.1007/s10067-003-0724-3

PMID:14576989

Abstract

The aim of this study was to investigate the relationship between the presence and titre of antibodies against C1q (anti-C1q Ab) and disease activity and renal involvement in patients with systemic lupus erythematosus (SLE). Anti-C1q Ab were measured in 79 patients with SLE (70 women and 9 men; mean age 41.7 years; mean disease duration 8.4 years): 19 patients had active disease with lupus nephritis, 8 active disease without nephritis, 26 inactive disease with nephritis and 26 inactive disease without nephritis. Anti-dsDNA antibodies (EIA and immunofluorescence), antiendothelial cell antibodies (AECA) and complement levels (C3, C4, total haemolytic complement activity) were determined in parallel. Anti-C1q Ab were positive in 49%, anti-dsDNA Ab in 61% and AECA in 19% of the patients, respectively. Significantly higher titres of anti-C1q Ab were found in patients with active disease compared with those with inactive SLE ( P < 0.01). Serum levels of anti-C1q Ab showed a positive correlation with anti-dsDNA Ab and SLEDAI score ( P < 0.01) and a negative correlation with C3 ( P < 0.05), C4 ( P < 0.01) and CH50U ( P < 0.01). The presence of anti-C1q Ab was not different between patients with or without nephritis. In patients with ( P < 0.05) and without nephritis ( P < 0.01) the frequency of anti-C1q Ab was significantly higher in active patients compared with inactive patients. Both anti-C1q and anti-ds-DNA Ab were detectable in 74% of patients with active nephritis but only in 30% of all other patients ( P=0.001). None of the patients with active nephritis was negative for anti-C1q and anti-dsDNA Ab, whereas 37% of the patients without active nephritis were negative for both antibodies ( P < 0.01). Sensitivity, specificity, positive and negative predictive values for active lupus nephritis among SLE patients were 100%, 50%, 51.9% and 100% for anti-dsDNA Ab (EIA) and 74%, 70%, 57% and 89.4% for positive findings of both anti-dsDNA and anti-C1q Ab. The presence and titre of anti-C1q-Ab in SLE are related to disease activity. Absence of anti-dsDNA Ab excludes active nephritis; positive findings of both anti-dsDNA Ab and anti-C1q Ab are of relatively high specificity for active nephritis.

摘要

本研究旨在探讨系统性红斑狼疮（SLE）患者中抗C1q抗体（抗C1q Ab）的存在及滴度与疾病活动度和肾脏受累情况之间的关系。对79例SLE患者（70例女性，9例男性；平均年龄41.7岁；平均病程8.4年）检测抗C1q Ab：19例患者患有狼疮性肾炎的活动性疾病，8例无肾炎的活动性疾病，26例有肾炎的非活动性疾病，26例无肾炎的非活动性疾病。同时检测抗双链DNA抗体（酶免疫分析和免疫荧光法）、抗内皮细胞抗体（AECA）及补体水平（C3、C4、总溶血补体活性）。患者中抗C1q Ab阳性率为49%，抗双链DNA Ab阳性率为61%，AECA阳性率为19%。与非活动性SLE患者相比，活动性疾病患者的抗C1q Ab滴度显著更高（P<0.01）。血清抗C1q Ab水平与抗双链DNA Ab及SLE疾病活动指数（SLEDAI）评分呈正相关（P<0.01），与C3（P<0.05）、C4（P<0.01）及CH50U（P<0.01）呈负相关。有肾炎和无肾炎患者的抗C1q Ab存在情况无差异。在有肾炎（P<0.05）和无肾炎（P<0.01）的患者中，活动性患者的抗C1q Ab频率显著高于非活动性患者。74%的活动性肾炎患者可检测到抗C1q和抗双链DNA Ab，而在所有其他患者中仅为30%（P=0.001）。活动性肾炎患者中无一例抗C1q和抗双链DNA Ab阴性，而无活动性肾炎患者中有37%两种抗体均为阴性（P<0.01）。SLE患者中活动性狼疮性肾炎的抗双链DNA Ab（酶免疫分析）的敏感性、特异性、阳性和阴性预测值分别为100%、50%、51.9%和100%，抗双链DNA和抗C1q Ab阳性结果的分别为74%、70%、57%和89.4%。SLE中抗C1q - Ab的存在及滴度与疾病活动度相关。抗双链DNA Ab阴性可排除活动性肾炎；抗双链DNA Ab和抗C1q Ab均为阳性结果对活动性肾炎具有相对较高的特异性。