van den Berg Loes, Nossent Hans, Rekvig Ole
Institute of Clinical Medicine, Rheumatology, University of Tromso Breivika, 9037 Tromso, Norway.
Clin Rheumatol. 2006 May;25(3):347-52. doi: 10.1007/s10067-005-0047-7. Epub 2005 Nov 23.
To determine if the past presence of anti-double-strand (ds)DNA antibody (Ab) will predict subsequent disease activity in patients with systemic lupus erythematosus (SLE).
A longitudinal study of clinical and serological disease manifestations registered during 2,412 patient months of follow-up in a well-defined lupus cohort. Organ-specific disease manifestations, the modified SLE disease activity index (M-SLEDAI) score, disease flares (M-SLEDAI increase > or =3) and predictive value of anti-dsDNA Ab testing [by enzyme-linked immunoabsorbent assay (ELISA) and Crithidia luciliae immunofluorescence (CLIFT) assays] were related to past anti-dsDNA Ab status.
Anti-dsDNA Ab was previously demonstrated in 54 (57%) patients (group 1), while they were not earlier detected in 40 (43%) patients (group 2). The number of patients experiencing flares (46 vs 25%, p<0.01), the total number of flares (75 vs 17, p<0,001) as well as overall (60 vs 24 per 100 patient years, p<0,001) and organ-specific flare rate were higher in group 1. After adjustment for control frequency, group 1 remained at a higher risk for renal flares [odds ratio (OR) 2.4; confidence interval (CI) 1.5-4.1], and group 2 was at a higher risk for skin flares (OR 0.7; CI 0.5-0.8). While anti-dsDNA Ab testing overall was performed slightly more often in group 1 (OR 1.45; CI 1.0-4.6), anti-dsDNA Ab testing during flares was similar in both groups.
The past presence of anti-dsDNA Ab identified patients with an increased risk of subsequent renal flares. However, as a new onset of anti-dsDNA Abs occurred late in the disease course, prior anti-dsDNA status was not adequate to predict disease flares.
确定既往抗双链（ds）DNA抗体（Ab）的存在是否能预测系统性红斑狼疮（SLE）患者随后的疾病活动。
对一个明确界定的狼疮队列中2412个患者月随访期间记录的临床和血清学疾病表现进行纵向研究。器官特异性疾病表现、改良SLE疾病活动指数（M-SLEDAI）评分、疾病发作（M-SLEDAI增加≥3）以及抗dsDNA Ab检测的预测价值[通过酶联免疫吸附测定（ELISA）和利什曼原虫免疫荧光（CLIFT）测定]与既往抗dsDNA Ab状态相关。
54例（57%）患者（第1组）既往检测到抗dsDNA Ab，而40例（43%）患者（第2组）早期未检测到。第1组中经历疾病发作的患者数量（46%对25%，p<0.01）、疾病发作总数（75次对17次，p<0.001）以及总体（每100患者年60次对24次，p<0.001）和器官特异性发作率均较高。在调整对照频率后，第1组发生肾脏发作的风险仍然较高[比值比（OR）2.4；置信区间（CI）1.5 - 4.1]，而第2组发生皮肤发作的风险较高（OR 0.7；CI 0.5 - 0.8）。虽然第1组总体上抗dsDNA Ab检测频率略高（OR 1.45；CI 1.0 - 4.6），但两组在疾病发作期间抗dsDNA Ab检测情况相似。
既往存在抗dsDNA Ab可识别出随后发生肾脏发作风险增加的患者。然而，由于抗dsDNA Abs的新发情况在疾病过程中出现较晚，既往抗dsDNA状态不足以预测疾病发作。
