抗N-甲基-D-天冬氨酸型受体亚型NR2a/2b抗体与神经精神性狼疮

目的 探讨抗N-甲基-D-天冬氨酸型(NMDA)受体亚型NR2a/2b抗体(抗NR2抗体)在神经精神性狼疮(NPSLE)患者免疫发病机制中的作用和意义.方法 采用酶联免疫吸附试验(ELISA)法检测59例NPSLE患者、54例无神经精神症状的系统性红斑狼疮(SLE)患者血清及20例NPSLE患者脑脊液中抗NR2抗体的水平,评价抗NR2抗体与NPSLE的临床表现、病情活动度评分(SLEDAI)、抗dsDNA抗体水平、抗核糖体P蛋白抗体、抗核抗体(ANA)、抗Sm抗体的相关性.结果 59例NPSLE患者血清中的抗NR2抗体水平显著高于54例非NPSLE患者.同时2组患者SLEDAI评分、抗Sm抗体阳性率、抗dsDNA抗体水平及抗核糖体P蛋白抗体水平差异均有统计学意义;59例NPSLE患者中,15例器质性脑病(认知功能障碍、记忆力减退)患者血清中的抗NR2抗体水平显著高于其他NPSLE患者;20例NPSLE患者脑脊液中仅有2例抗NR2抗体高滴度阳性,二者血清中的抗NR2抗体同样高滴度阳性,此2例患者均表现为认知功能障碍、记忆力减退,二者预后差.结论 检测SLE患者血清中的抗NMDA受体亚型NR2a/2b抗体对于NPSLE具有初步筛选作用;在表现为认知功能障碍、记忆力减退的NPSLE患者的血清及脑脊液中存在高滴度的抗NMDA受体亚型NR2a/2b抗体.

The anti-NR2 antibody in neuropsychiatric lupus erythematosus

Objective To study the immunopathogenesis mediated by antibodies against N-methyl-D-aspartate (NMDA) receptor type NR2a or NR2b in neuropsychiatric lupus erythematosus. Methods Sera samples of 59 NPSLE patients and 54 non-NPSLE patients, CSF samples of 20 patients with NPSLE were examined for the anti-NR2 antibody by ELISA.We evaluated the correlation between anti-NR2 antibody and other clinical parameters including clinical manifestations, SLEDAI, anti-ribosomal P protein antibody, anti-Smith antibody and anti-dsDNA antibody.Results Sera anti-NR2 antibody in 59 NPSLE patients was significantly higher than 54 non-NPSLE patients. Furthermore, there were other significant differences between NPSLE patients and non-NPSLE patients, such as SLEDAI, anti-dsDNA antibody, anti-ribosomal P protein antibodies and anti-Smith antibody.Sera anti-NR2 antibody in 15 patients with organic brain syndrome was significantly higher than that of other NPSLE patients .CSF anti-NR2 antibody in two NPSLE patients who had cognitive and psychological disturbances was significantly higher than that of other 18 NPSLE patients.These two patients died soon after the onset of NPSLE.Conclusion The anti-NR2 antibody may be the early diagnostic parameter of NPSLE.Anti-NR2 antibody in NPSLE patients who have cognitive and psychological disturbances is significantly higher than that of other NPSLE patients.