系统性红斑狼疮患者血清α-肌动蛋白抗体状态及其在狼疮性肾炎诊断中的潜力。
Serum alpha-actinin antibody status in systemic lupus erythematosus and its potential in the diagnosis of lupus nephritis.
作者信息
Babaei Mansour, Rezaieyazdi Zahra, Saadati Nayereh, Saghafi Massoud, Sahebari Maryam, Naghibzadeh Bahram, Esmaily Habibollah
机构信息
Department of Rheumatology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran.
Rheumatic Disease Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
出版信息
Caspian J Intern Med. 2016 Fall;7(4):272-277.
BACKGROUND
In lupus nephritis (LN), deposition of pathogenic autoantibodies in the glomeruli is mediated via cross-reactivity with alpha-actinin. Association of serum alpha-actinin antibody (AαA) with LN has been shown in a few studies but the results are controversial.
METHODS
Eighty patients into entered the study. The diagnosis of SLE was confirmed according to the American College of Rheumatology criteria and LN was diagnosed by proteinuria ≥ 500 mg/24 hour and kidney biopsy. Serum AαA was measured with ELISA method. Receiver operating characteristics curve (ROC) analysis was applied to determine an optimal cutoff value for AαA to discriminate patients with and without LN at the highest sensitivity and specificity. The association of AαA with LN was determined by logistic regression analysis with calculation of odds ratio (OR).
RESULTS
Serum AαA was significantly lower in LN as compared with SLE patients without LN (P=0.001). Serum AαA at cutoff levels ≤ 59.5 pg/ml discriminated the two groups with sensitivity, specificity, positive predictive values of 60%. 90% and 85.7%, respectively. Serum AαA level ≤ 59.5 pg/ml was significantly associated with LN (OR=13.5, P=0.001) and the OR increased to 25.2 (P=0.003) after adjustment for age, sex, C3, C4, anti-ds-DNA, SLEDAI.
CONCLUSION
This study indicates that serum AαA decreases in LN and serum level ≤ 59.5 pg/ml is SLE and is predictive of nephritis.
背景
在狼疮性肾炎（LN）中，致病性自身抗体在肾小球中的沉积是通过与α-辅肌动蛋白的交叉反应介导的。少数研究显示血清α-辅肌动蛋白抗体（AαA）与LN有关，但结果存在争议。
方法
80例患者进入本研究。根据美国风湿病学会标准确诊SLE，根据蛋白尿≥500mg/24小时及肾活检诊断LN。采用ELISA法检测血清AαA。应用受试者工作特征曲线（ROC）分析确定AαA的最佳截断值，以最高的敏感性和特异性区分有LN和无LN的患者。通过逻辑回归分析计算比值比（OR）来确定AαA与LN的关联。
结果
与无LN的SLE患者相比，LN患者的血清AαA显著降低（P = 0.001）。截断水平≤59.5pg/ml的血清AαA区分两组的敏感性、特异性、阳性预测值分别为60%、90%和85.7%。血清AαA水平≤59.5pg/ml与LN显著相关（OR = 13.5，P = 0.001），在调整年龄、性别、C3、C4、抗双链DNA、SLE疾病活动指数（SLEDAI）后，OR增加至25.2（P = 0.003）。
结论
本研究表明LN患者血清AαA降低，血清水平≤59.5pg/ml对SLE及肾炎具有预测价值。
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