Tikly M, Gould T, Wadee A A, van der Westhuizen E, Mokgethwa B B N
Division of Rheumatology, Department of Medicine, Chris Hani Baragwanath Hospital and University of the Witwatersrand, P.O. Bertsham 2013, Johannesburg, South Africa.
Department of Immunology, National Health Laboratory Services and University of the Witwatersrand, Johannesburg, South Africa.
Clin Rheumatol. 2007 Dec;26(12):2121-2125. doi: 10.1007/s10067-007-0637-7. Epub 2007 May 22.
Antinucleosome antibodies (AnuA) are increasingly recognized as an important biomarker in the diagnosis and subset stratification of patients with systemic lupus erythematosus (SLE). The aim of the study was to determine the sensitivity, specificity, and clinico-serological correlates of AnuA in black South Africans with SLE. We performed a cross-sectional study of 86 SLE patients attending a tertiary center and 87 control subjects. AnuA were tested using a second-generation enzyme-linked immunosorbent assay (ELISA). The sensitivity, specificity, positive predictive value, and negative predictive value of AnuA were 45.3, 94.3, 88.6, and 63.6%, respectively. The presence of AnuA were strongly associated with the co-presence of anti-dsDNA antibodies (OR = 3.4, p < 0.0005) and antihistone antibodies (OR = 15.7, p < 0.00001). Patients who were seropositive for AnuA were more likely to have skin involvement (discoid lupus and/or malar rash) and had higher SLE disease activity index (SLEDAI) scores and Systemic Lupus International Collaborative Clinics/American College of Rheumatology (SLICC/ACR) damage scores (p < 0.05). IgG anticardiolipin antibody (aCL) levels showed a significant correlation with AnuA ratios (p < 0.01). Our findings provide further evidence that AnuA are a sensitive and specific diagnostic biomarker in SLE. Moreover, our finding that the presence of AnuA, but not anti-dsDNA antibodies, are associated with worse SLICC/ACR damage scores suggest that AnuA may have a role in predicting disease outcome. The correlation between IgG aCL and AnuA is a novel finding that merits further studies to determine possible common peptide specificities of the antibodies.
抗核小体抗体（AnuA）越来越被认为是系统性红斑狼疮（SLE）患者诊断和亚组分层中的一种重要生物标志物。本研究的目的是确定AnuA在南非黑人SLE患者中的敏感性、特异性以及临床血清学相关性。我们对一家三级中心的86例SLE患者和87例对照受试者进行了一项横断面研究。使用第二代酶联免疫吸附测定（ELISA）检测AnuA。AnuA的敏感性、特异性、阳性预测值和阴性预测值分别为45.3%、94.3%、88.6%和63.6%。AnuA的存在与抗双链DNA（dsDNA）抗体（比值比[OR]=3.4，p<0.0005）和抗组蛋白抗体（OR=15.7，p<0.00001）的同时存在密切相关。AnuA血清学阳性的患者更有可能出现皮肤受累（盘状狼疮和/或颊部皮疹），并且具有更高的SLE疾病活动指数（SLEDAI）评分和系统性红斑狼疮国际协作临床/美国风湿病学会（SLICC/ACR）损伤评分（p<0.05）。IgG抗心磷脂抗体（aCL）水平与AnuA比值呈显著相关性（p<0.01）。我们的研究结果进一步证明AnuA是SLE中一种敏感且特异的诊断生物标志物。此外，我们发现AnuA的存在而非抗dsDNA抗体与更差的SLICC/ACR损伤评分相关，这表明AnuA可能在预测疾病转归方面发挥作用。IgG aCL与AnuA之间的相关性是一项新发现，值得进一步研究以确定这些抗体可能的共同肽段特异性。
