Ghirardello A, Doria A, Zampieri S, Tarricone E, Tozzoli R, Villalta D, Bizzaro N, Piccoli A, Gambari P F
Department of Medical and Surgical Sciences, Division of Rheumatology, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy.
J Autoimmun. 2004 May;22(3):235-40. doi: 10.1016/j.jaut.2003.12.005.
We prospectively analyzed the diagnostic sensitivity and specificity as well as the clinical relevance of antinucleosome antibodies in SLE. One hundred and one consecutive SLE patients were followed for 3 years. Three serial serum samples from each patient were tested for antinucleosome antibodies by ELISA (optimum cut-off value 10 U/ml), and for anti-dsDNA antibody (by ELISA and IIF on Crithidia luciliae), and anti-dsDNA avidity (by Scatchard plot analysis). Sera from 100 healthy individuals (HI), 35 patients with systemic sclerosis (SSc), 30 with primary Sjögren's syndrome (SS), 20 with rheumatoid arthritis (RA) and 48 with infectious diseases (ID), were assayed as controls. SLE activity and damage were evaluated using the ECLAM score and the SLICC/ACR index. At baseline, antinucleosome antibodies were found in 87 patients with SLE (86.1%), in 8 patients with SSc (22.8%), in 2 HI (2%), and in 1 ID (2.1%). The sensitivity and specificity of antinucleosome testing for SLE were 86.1% and 95.3%, respectively. The prevalence of antinucleosome antibodies in SLE was significantly higher than that of anti-dsDNA antibodies, with a correlation between them. No relevant relationship was found between antinucleosome antibodies and disease features, including renal involvement, disease activity, and disease damage. During follow-up, no significant variation was observed in antinucleosome level, nor in anti-dsDNA antibody level or avidity. We conclude that antinucleosome antibodies are commonly found in SLE. Low antibody levels can be detected in SSc, whereas medium/high levels are highly specific for SLE. Their clinical relevance during the disease course and utility for monitoring the individual patient seem to be poor.
我们前瞻性地分析了抗核小体抗体在系统性红斑狼疮（SLE）中的诊断敏感性、特异性及其临床相关性。对101例连续的SLE患者进行了3年的随访。通过酶联免疫吸附测定法（ELISA，最佳临界值为10 U/ml）检测每位患者的3份连续血清样本中的抗核小体抗体、抗双链DNA抗体（通过ELISA和利什曼原虫间接免疫荧光法检测）以及抗双链DNA亲和力（通过Scatchard作图分析）。检测了100名健康个体（HI）、35例系统性硬化症（SSc）患者、30例原发性干燥综合征（SS）患者、20例类风湿关节炎（RA）患者和48例传染病（ID）患者的血清作为对照。使用欧洲狼疮活动度测量（ECLAM）评分和系统性红斑狼疮国际协作临床（SLICC）/美国风湿病学会（ACR）指数评估SLE的活动度和损伤情况。在基线时，87例SLE患者（86.1%）、8例SSc患者（22.8%）、2例HI（2%）和1例ID患者（2.1%）中检测到抗核小体抗体。抗核小体检测对SLE的敏感性和特异性分别为86.1%和95.3%。SLE中抗核小体抗体的患病率显著高于抗双链DNA抗体，且两者之间存在相关性。未发现抗核小体抗体与疾病特征（包括肾脏受累、疾病活动度和疾病损伤）之间存在相关性。在随访期间，抗核小体水平、抗双链DNA抗体水平或亲和力均未观察到显著变化。我们得出结论，抗核小体抗体在SLE中常见。在SSc中可检测到低水平抗体，而中/高水平抗体对SLE具有高度特异性。它们在疾病过程中的临床相关性以及用于监测个体患者的效用似乎较差。
