三种方法检测抗双链DNA抗体的比较及临床意义

目的利用绿蝇短膜虫间接免疫荧光法（CL-IIF）、欧蒙酶免疫斑点法、胶体金快速斑点法3种方法单独及不同组合联合检测抗双链DNA（ds-DNA）抗体的比较,了解3种方法联合检测在系统性红斑狼疮（SLE）中的诊断及临床应用价值。方法120例SLE患者分为疾病活动组和疾病稳定组,另选择121例疾病对照（干燥综合征35例、混合性结缔组织病30例、类风湿关节炎38例、系统性硬化症18例患者血清）、40例健康患者血清对照,利用3种方法检测其血清中抗ds-DNA抗体,了解检测的敏感性和特异性,并寻找对临床有价值的联合检测方法。结果CL-IIF法、欧蒙酶免疫斑点法、胶体金快速斑点法在SLE中的敏感性分别为45.8%、42.5%、47.5%,均明显高于疾病对照组及健康对照组,差异有统计学意义（P〈0.01）;在检测SLE疾病活动组抗ds-DNA抗体中,3种方法敏感性分别为65.2%、58.3%、61.1%,而在疾病稳定组中敏感性分别为16.6%、18.7%、27.0%,差异有统计学意义（P〈0.01）;3种方法的联合检测可以明显提高抗ds-DNA抗体在SLE中的检出率,而特异性仍然很高。结论3种方法检测SLE中的抗ds-DNA抗体均具有很高特异性,但敏感性略低,尤其在疾病稳定期中,而3种方法间的联合检测则可以弥补敏感性低的不足,尤其是CL-IIF法和胶体金快速斑点法的组合更适合临床应用。

Three methods in combination to determine anti-dsDNA antibody and its application in systemic lupus erythematosus

Objective To compare efficiencies of CL-IIF, Euro immunoblot assay and DIGFA determining anti-dsDNA antibody by single or in different combination, and to investigate the diagnostic and applicable value of combined detection in systemic lupus erythematosus.Methods 120 cases of SLE were divideded into active and stable stage group. 121 disease controls included 35 cases of primary SS, 30 cases of MCTD, 38 cases of RA,and 18 cases of PSS. Forty healthy adults were selected as healthy controls. The serum anti-dsDNA antibody was detected with three methods by single or in different combination, and their respective sensitivity and specificity were compared.Results The sensitivity of CL-IIF, Euro immunoblot assay and DIGFA in diagnosing SLE was 45.8%, 42.5% and 47.5% respectively, higher than that of disease control group and healthy control group. When each of the three methods was applied to test active SLE, the sensitivity was 65.2%, 58.3% and 61.1% respectively. As far as stable cases concerned, the sensitivity was 16.6%, 18.7% and 27.0% respectively, and the difference had statistical significance. The sensitivity in detecting anti-dsDNA antibody in SLE cases increased markedly and kept a favorable specificity when the three methods were applied in combination.Conclusion Each of CL-IIF, Euro immunoblot assay and DIGFA has a high specificity in diagnosing SLE, however, their respective sensitivity decreases in stable cases of SLE. When the three methods are applied in combination to diagnose SLE, we can counter against the defect of low sensitivity. Especially, the combination of CL-IIF and DIGFA is much more applicable than other ways of combination.