Harrison Melanie J, Ravdin Lisa D, Lockshin Michael D
Hospital for Special Surgery and Weill Medical College of Cornell University, New York, New York 10021, USA.
Arthritis Rheum. 2006 Aug;54(8):2515-22. doi: 10.1002/art.22030.
To assess the association between serum NR2a antibodies and cognitive dysfunction in systemic lupus erythematosus (SLE).
The study population consisted of English-speaking adults who met American College of Rheumatology (ACR) criteria for SLE and had at least 1 serum sample stored in the Hospital for Special Surgery Autoimmune Registry and Repository. Demographic and clinical information was obtained, and patients completed the neuropsychological test battery recommended by the ACR, the Center for Epidemiologic Studies Depression Scale, and the Spielberger State-Trait Anxiety Inventory. Cognitive impairment was defined as scores >1.5 SD below the mean of age-matched published normative data on at least 2 neuropsychological tests. Sera were tested for NR2a antibodies by enzyme-linked immunosorbent assay. Performance on neuropsychological tests was compared between NR2a-positive and NR2a-negative patients.
Of the 93 patients, 24 (25.8%) were positive for NR2a antibodies. Of the 48 patients who were cognitively impaired based on test results, 31% were positive for NR2a antibodies, compared with 20% of those who were not cognitively impaired (P = 0.24). Among antibody-positive patients, the mean +/- SD number of neuropsychological tests with abnormal results was 2.3 +/- 2.2, compared with 2.0 +/- 1.8 in the antibody-negative group (P = 0.59). Similar nonsignificant differences were found when impairment was defined using a more stringent definition (i.e., test scores >2.0 SD below the mean) and using a neuropsychologist's clinical ratings. No association was detected between NR2a antibody positivity and depressive symptoms (P = 0.73) or anxiety (P = 0.42).
No significant association was found between NR2a antibody positivity and cognitive dysfunction, depressive symptoms, or anxiety. These results indicate that the presence of these antibodies alone does not have a direct effect on cognitive functioning or any other neuropsychiatric manifestation of SLE.
评估系统性红斑狼疮（SLE）患者血清NR2a抗体与认知功能障碍之间的关联。
研究人群包括符合美国风湿病学会（ACR）SLE标准、至少有1份血清样本存储于特种外科医院自身免疫登记库和储存库的成年英语使用者。收集人口统计学和临床信息，患者完成ACR推荐的神经心理测试组、流行病学研究中心抑郁量表以及斯皮尔伯格状态-特质焦虑量表。认知障碍定义为在至少2项神经心理测试中得分低于年龄匹配的已发表常模数据平均值1.5个标准差以上。采用酶联免疫吸附测定法检测血清中的NR2a抗体。比较NR2a抗体阳性和阴性患者在神经心理测试中的表现。
93例患者中，24例（25.8%）NR2a抗体呈阳性。根据测试结果，48例认知功能障碍患者中，31%的患者NR2a抗体呈阳性，而认知功能未受损患者中这一比例为20%（P = 0.24）。在抗体阳性患者中，神经心理测试结果异常的平均数量±标准差为2.3±2.2，抗体阴性组为2.0±1.8（P = 0.59）。当使用更严格的定义（即测试得分低于平均值2.0个标准差以上）和神经心理学家的临床评分来定义损伤时，也发现了类似的无显著差异。未检测到NR2a抗体阳性与抑郁症状（P = 0.73）或焦虑（P = 0.42）之间存在关联。
未发现NR2a抗体阳性与认知功能障碍、抑郁症状或焦虑之间存在显著关联。这些结果表明，仅这些抗体的存在对认知功能或SLE的任何其他神经精神表现没有直接影响。
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