抗双链 DNA 同种型和抗 C1q 抗体提高系统性红斑狼疮的诊断特异性。
Anti-Double-Stranded DNA Isotypes and Anti-C1q Antibody Improve the Diagnostic Specificity of Systemic Lupus Erythematosus.
机构信息
Clinical Laboratory of Nephrology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Blood Transfusion Department, Shanghai Xuhui Central Hospital, Shanghai 200031, China.
出版信息
Dis Markers. 2018 Sep 27;2018:4528547. doi: 10.1155/2018/4528547. eCollection 2018.
OBJECTIVES
We aimed to evaluate the value of immunoglobulin (Ig) G, IgM, and IgA isotypes of anti-double-stranded DNA (anti-dsDNA) and anti-C1q antibody in diagnosing systemic lupus erythematosus (SLE) patients and elucidate their association with disease activity and lupus nephritis.
METHODS
Blood samples were obtained from 96 SLE patients, 62 other autoimmune disease patients, and 60 healthy blood donors. Anti-dsDNA IgG, IgM, and IgA isotypes and anti-C1q antibody were measured by enzyme-linked immunosorbent assay. Disease activity of SLE patients was assessed according to the SLE Disease Activity Index score.
RESULTS
When specificity was greater than 90%, the sensitivity of anti-dsDNA IgG, IgM, and IgA isotypes and anti-C1q antibody in diagnosing SLE was 75%, 45%, 33%, and 49%, respectively. The prevalence of anti-dsDNA IgG ( = 0.002), anti-dsDNA IgA ( = 0.028), and anti-C1q antibody ( = 0.000) in active cases was significantly higher than those in inactive ones. In addition, the presence of anti-C1q antibody was associated with renal involvement ( = 0.032). Anti-dsDNA IgM showed no significant association with disease activity, but it was inversely linked with lupus nephritis ( = 0.005). When anti-dsDNA IgG and IgA and anti-C1q were combined to evaluate SLE disease activity, the specificity reached the highest level (90%). When anti-C1q positive was accompanied by anti-dsDNA IgM negative, the specificity of diagnosing lupus nephritis was up to 96%.
CONCLUSIONS
This study demonstrated the role of anti-dsDNA IgG, IgM, and IgA isotypes and anti-C1q antibody alone or combination in diagnosing SLE. Anti-dsDNA IgG and IgA and anti-C1q were shown to be associated with disease activity, while anti-dsDNA IgM and anti-C1q were associated with lupus nephritis. When the related antibodies were combined, the diagnostic specificity was significantly higher.
目的
我们旨在评估 IgG、IgM 和 IgA 同种型抗双链 DNA（抗 dsDNA）和抗 C1q 抗体在诊断系统性红斑狼疮（SLE）患者中的价值，并阐明其与疾病活动度和狼疮肾炎的关系。
方法
采集 96 例 SLE 患者、62 例其他自身免疫性疾病患者和 60 例健康献血者的血样。采用酶联免疫吸附试验测定抗 dsDNA IgG、IgM 和 IgA 同种型和抗 C1q 抗体。根据 SLE 疾病活动指数评分评估 SLE 患者的疾病活动度。
结果
当特异性大于 90%时，抗 dsDNA IgG、IgM 和 IgA 同种型和抗 C1q 抗体诊断 SLE 的敏感性分别为 75%、45%、33%和 49%。在活动病例中，抗 dsDNA IgG（=0.002）、抗 dsDNA IgA（=0.028）和抗 C1q 抗体（=0.000）的患病率明显高于非活动病例。此外，抗 C1q 抗体的存在与肾脏受累有关（=0.032）。抗 dsDNA IgM 与疾病活动度无显著相关性，但与狼疮肾炎呈负相关（=0.005）。当联合评估抗 dsDNA IgG、IgA 和抗 C1q 以评估 SLE 疾病活动度时，特异性达到最高水平（90%）。当抗 C1q 阳性伴抗 dsDNA IgM 阴性时，诊断狼疮肾炎的特异性高达 96%。
结论
本研究表明，抗 dsDNA IgG、IgM 和 IgA 同种型和抗 C1q 抗体单独或联合在诊断 SLE 中具有一定作用。抗 dsDNA IgG 和 IgA 以及抗 C1q 与疾病活动度相关，而抗 dsDNA IgM 和抗 C1q 与狼疮肾炎相关。当相关抗体联合使用时，诊断特异性显著提高。
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