系统性红斑狼疮诊断时的自身抗体与神经精神事件：一项国际初始队列研究的结果
Autoantibodies and neuropsychiatric events at the time of systemic lupus erythematosus diagnosis: results from an international inception cohort study.
作者信息
Hanly J G, Urowitz M B, Siannis F, Farewell V, Gordon C, Bae S C, Isenberg D, Dooley M A, Clarke A, Bernatsky S, Gladman D, Fortin P R, Manzi S, Steinsson K, Bruce I N, Ginzler E, Aranow C, Wallace D J, Ramsey-Goldman R, van Vollenhoven R, Sturfelt G, Nived O, Sanchez-Guerrero J, Alarcón G S, Petri M, Khamashta M, Zoma A, Font J, Kalunian K, Douglas J, Qi Q, Thompson K, Merrill J T
机构信息
Division of Rheumatology, Nova Scotia Rehabilitation Centre (2nd floor), Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
出版信息
Arthritis Rheum. 2008 Mar;58(3):843-53. doi: 10.1002/art.23218.
OBJECTIVE
To examine, in an inception cohort of systemic lupus erythematosus (SLE) patients, the association between neuropsychiatric (NP) events and anti-ribosomal P (anti-P), antiphospholipid (lupus anticoagulant [LAC], anticardiolipin), anti-beta2-glycoprotein I, and anti-NR2 glutamate receptor antibodies.
METHODS
NP events were identified using the American College of Rheumatology case definitions and clustered into central/peripheral and diffuse/focal events. Attribution of NP events to SLE was determined using decision rules of differing stringency. Autoantibodies were measured without knowledge of NP events or their attribution.
RESULTS
Four hundred twelve patients were studied (87.4% female; mean +/- SD age 34.9 +/- 13.5 years, mean +/- SD disease duration 5.0 +/- 4.2 months). There were 214 NP events in 133 patients (32.3%). The proportion of NP events attributed to SLE varied from 15% to 36%. There was no association between autoantibodies and NP events overall. However, the frequency of anti-P antibodies in patients with central NP events attributed to SLE was 4 of 20 (20%), versus 3 of 107 (2.8%) in patients with other NP events and 24 of 279 (8.6%) in those with no NP events (P = 0.04). Among patients with diffuse NP events, 3 of 11 had anti-P antibodies (27%), compared with 4 of 111 patients with other NP events (3.6%) and 24 of 279 of those with no NP events (8.6%) (P = 0.02). Specific clinical-serologic associations were found between anti-P and psychosis attributed to SLE (P = 0.02) and between LAC and cerebrovascular disease attributed to SLE (P = 0.038). There was no significant association between other autoantibodies and NP events.
CONCLUSION
Clinically distinct NP events attributed to SLE and occurring around the time of diagnosis were found to be associated with anti-P antibodies and LAC. This suggests that there are different autoimmune pathogenetic mechanisms, although low sensitivity limits the clinical application of testing for these antibodies.
目的
在一个系统性红斑狼疮（SLE）患者的起始队列中，研究神经精神（NP）事件与抗核糖体P（抗-P）、抗磷脂（狼疮抗凝物[LAC]、抗心磷脂）、抗β2糖蛋白I及抗NR2谷氨酸受体抗体之间的关联。
方法
使用美国风湿病学会的病例定义来识别NP事件，并将其分为中枢性/外周性和弥漫性/局灶性事件。使用不同严格程度的决策规则来确定NP事件与SLE的相关性。在不知道NP事件及其相关性的情况下检测自身抗体。
结果
共研究了412例患者（87.4%为女性；平均±标准差年龄34.9±13.5岁，平均±标准差病程5.0±4.2个月）。133例患者发生了214次NP事件（32.3%）。归因于SLE的NP事件比例从15%到36%不等。总体而言，自身抗体与NP事件之间无关联。然而，在归因于SLE的中枢性NP事件患者中，抗-P抗体的频率为20例中的4例（20%），而在其他NP事件患者中为107例中的3例（2.8%），在无NP事件患者中为279例中的24例（8.6%）（P = 0.04）。在弥漫性NP事件患者中，11例中有3例有抗-P抗体（27%），相比之下，111例其他NP事件患者中有4例（3.6%），279例无NP事件患者中有24例（8.6%）（P = 0.02）。发现抗-P与归因于SLE的精神病之间（P = 0.02）以及LAC与归因于SLE的脑血管疾病之间（P = 0.038）存在特定的临床-血清学关联。其他自身抗体与NP事件之间无显著关联。
结论
发现归因于SLE且发生在诊断前后的临床上不同的NP事件与抗-P抗体和LAC有关。这表明存在不同的自身免疫发病机制，尽管低敏感性限制了这些抗体检测在临床上的应用。
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