系统性红斑狼疮患者的抗核小体抗体：作为诊断工具和疾病活动标志物的潜在效用及其与抗双链DNA抗体的比较。

Anti-nucleosome antibodies in patients with systemic lupus erythematosus: potential utility as a diagnostic tool and disease activity marker and its comparison with anti-dsDNA antibody.

作者信息

Saigal Renu, Goyal Laxmi Kant, Agrawal Abhishek, Mehta Archna, Mittal Pradeep, Yadav R N, Meena P D, Wadhvani Dilip

出版信息

J Assoc Physicians India. 2013 Jun;61(6):372-7.

Abstract

OBJECTIVE

To compare the utility of anti-nucleosome antibodies and anti-dsDNA antibodies in diagnosis of Systemic Lupus Erythematosus (SLE) and as a marker of disease activity.

METHODS

This is a hospital based observational study among 40 (37 females and 3 males) selected cases of SLE (> or = 4 ACR criteria) and 80 control. 40 cases of other systemic autoimmune disease (SAD) [e g. 29 cases of Rheumatoid arthritis, 4 cases of Systemic sclerosis/scleroderma, 4 cases of Sjögren syndrome, 3 cases of MCTD and 40 Healthy blood were taken as control. From each patient venous blood samples were collected and submitted for anti-nucleosome and anti-dsDNA antibodies assay by enzyme linked immunosorbent assay (ELISA).

RESULTS

Anti-nucleosome antibodies were positive in 19 (47.5%) SLE, 02 (05%) other SAD and none of the healthy persons. Anti dsDNA antibodies were positive in 15 (37.5%) SLE patients, 07 (17.5%) other SAD and 01(2.5%) healthy persons. For diagnosis of SLE, sensitivity of anti-ds DNA and anti-nucleosome antibody was found to be 37.5% and 47.50% respectively. The specificity of anti-nucleosome was 100% and that of anti-dsDNA was 97.50%. So, anti-nucleosome antibody test is more specific and more sensitive for diagnosis of SLE than anti-dsDNA. When SLE cases were compared with SAD, sensitivity of anti-dsDNA and anti-nucleosome antibody, for diagnosis of SLE, found to be 37.50% and 47.50% respectively but the specificity of anti-nucleosome was 95% and that of anti-dsDNA was 82.50%. Both antibodies show positive correlation with SLEDAI score .The correlation coefficient was stronger for anti-dsDNA antibodies (r = +0.550, P = < .001) than anti-nucleosome antibodies (r = +0.332, P = < .05) CONCLUSIONS: Anti-nucleosome antibodies show higher positivity than anti-dsDNA antibodies among SLE than other SAD and healthy population. Anti-nucleosome antibodies are more sensitive and specific for the diagnosis of SLE than anti-dsDNA antibodies. Anti-nucleosome and anti-dsDNA both show positive correlation with SLEDAI. But anti-dsDNA antibodies show stronger correlation with SLEDAI than anti-nucleosome. So, anti-nucleosome antibodies can be used as an additional marker for diagnosis of SLE and SLE disease activity.

摘要

目的

比较抗核小体抗体和抗双链DNA抗体在系统性红斑狼疮（SLE）诊断及作为疾病活动标志物方面的效用。

方法

这是一项基于医院的观察性研究，选取了40例（37名女性和3名男性）符合SLE（≥4条美国风湿病学会（ACR）标准）的病例以及80名对照。40例其他系统性自身免疫性疾病（SAD）[例如，29例类风湿关节炎、4例系统性硬化症/硬皮病、4例干燥综合征、3例混合性结缔组织病（MCTD）]以及40名健康者作为对照。采集每位患者的静脉血样本，通过酶联免疫吸附测定（ELISA）法检测抗核小体和抗双链DNA抗体。

结果

19例（47.5%）SLE患者抗核小体抗体呈阳性，2例（5%）其他SAD患者抗核小体抗体呈阳性，健康者中无人抗核小体抗体呈阳性。15例（37.5%）SLE患者抗双链DNA抗体呈阳性，7例（17.5%）其他SAD患者抗双链DNA抗体呈阳性，1例（2.5%）健康者抗双链DNA抗体呈阳性。对于SLE的诊断，抗双链DNA和抗核小体抗体的敏感性分别为37.5%和47.50%。抗核小体抗体的特异性为100%，抗双链DNA抗体的特异性为97.50%。因此，抗核小体抗体检测在SLE诊断中比抗双链DNA抗体更具特异性和敏感性。当将SLE病例与SAD进行比较时，抗双链DNA和抗核小体抗体对SLE诊断的敏感性分别为37.50%和47.50%，但抗核小体抗体的特异性为95%，抗双链DNA抗体的特异性为82.50%。两种抗体均与SLE疾病活动指数（SLEDAI）评分呈正相关。抗双链DNA抗体的相关系数（r = +0.550，P = <.001）比抗核小体抗体（r = +0.332，P = <.05）更强。结论：在SLE患者中，抗核小体抗体的阳性率高于抗双链DNA抗体，高于其他SAD患者和健康人群。抗核小体抗体在SLE诊断中比抗双链DNA抗体更敏感、更具特异性。抗核小体和抗双链DNA均与SLEDAI呈正相关。但抗双链DNA抗体与SLEDAI的相关性比抗核小体抗体更强。因此，抗核小体抗体可作为SLE诊断及SLE疾病活动的附加标志物。