自身抗体联合体液免疫检测在SLE中的应用价值

目的 探讨联合检测自身抗体、免疫球蛋白和补体在系统性红斑狼疮(SLE)诊断和病情判断中的应用价值.方法 选取SLE患者54例、其他自身免疫性疾病患者32例和正常对照30例,采用间接免疫荧光法测定抗核抗体(ANA)、免疫印迹法测定抗核提取物抗体(抗ENA抗体)、散射免疫比浊法测定免疫球蛋白和补体C3、C4.结果 SLE患者的ANA、抗dsDNA、抗Sm、抗核小体、抗U1-nRNP、抗核糖体P蛋白、抗组蛋白抗体的检测阳性率分别为87.04％、59.26％、27.78％、29.63％,37.04％、12.96％、27.78％;SLE活动组中抗dsDNA和抗核小体抗体的阳性率高于SLE非活动组,差异具有统计学意义(P＜0.05);SLE活动组IgG、IgA、IgM水平高于正常对照组,C3、C4水平低于正常对照组,差异具有统计学意义(P＜0.01).结论 自身抗体联合免疫球蛋白和补体检测对SLE患者的临床诊断和病情判断有良好的参考价值.     

不同状态下系统性红斑狼疮与补体的相关性分析

目的观察不同状态下系统性红斑狼疮(systemic lupus erythematosus,SLE)患者补体C3、C4水平变化并探讨其临床意义。方法选取326例系统性红斑狼疮患者作为本次研究对象。按照抗双链DNA(dsDNA)抗体阴阳性分为dsDNA阴性及阳性组,按照抗核抗体(ANA)核型分为阴性、均质型、斑点型、核仁型及其他型组。比较两种分组方式下C3、C4的结果。结果dsDNA阳性患者C3、C4水平均低于阴性患者,差异具有统计学意义(P<0.05);ANA为均质型、斑点型及其他型患者C3、C4水平均低于ANA阴性组及核仁型组患者,差异具有统计学意义(P<0.05)。结论不同状态下系统性红斑狼疮患者补体C3、C4水平存在差异,联合检测补体C3、C4有助于对SLE病情活动性及自身抗体类型作出判断。     

联检抗C1q抗体、ds-DNA、抗-核小体、抗-Sm、ANA在狼疮性肾炎中的临床意义

系统性红斑狼疮（SLE）是一种多器官受累并产生自身抗体参与免疫介导的组织损伤为特征的疾患。SLE常累及肾脏,临床上又称为狼疮性肾炎（lupus nephritis,LN）。SLE合并LN患者血清中可检测出多种自身抗体,其中抗核抗体（ANA）、抗双链DNA（dsDNA）抗体、抗-核小体抗体、抗-Sm抗体作为较特异性血清标记抗体广泛应用于临床诊断,我们现增加了抗C1q抗体的检测对40例SLE合并LN的患者进行这五种抗体的联检并加以探讨。     

白癜风患者血清免疫球蛋白、补体、自身抗体检测及分析

目的 检测白癜风患者血清中免疫球蛋白IgG、IgA、IgM,补体C3、C4,抗核抗体(ANA)、抗甲状腺过氧化物酶抗体(A-TPO)、抗甲状腺球蛋白抗体(A-TG)的水平并进行比较分析.方法 收集门诊确诊为白癜风的患者血清168例和正常体检人群血清88例,性别、年龄分布无统计学差异,采用速率散射比浊法检测白免疫球蛋白IgG、IgA、IgM和补体C3、C4,采用ELISA法检测抗核抗体,采用电化学发光免疫分析法检测A-TPO、A-TG,结果用SPSS19.0统计软件进行分析.结果 白癜风患者组血清中免疫球蛋白IgG、IgA、IgM,补体C3、C4表达水平与正常人对照组差异不具有统计学意义(P＞0.05);白癜风组与正常对照组ANA阳性率分别为8.1％和5.7％,经比较差异不具有统计学意义(P＞0.05);两组间A-TPO的阳性率分别为18.8％和10.2％,差异有统计学意义(P＜0.05);两组A-TG阳性率分别为25.8％和4.5％,经比较差异具有统计学意义(P＜0.01).结论 部分白癜风患者存在体液免疫紊乱,在发病机制上可能与自身免疫性甲状腺疾病有相似之处;免疫球蛋白、补体及抗核抗体等免疫指标的检测在白癜风诊治中评价的意义不大.     

抗核抗体系列检测对狼疮性肾炎进行鉴别诊断的临床意义

目的探讨抗核抗体(ANA)系列指标在狼疮性肾炎(LN)患者中的表达情况及临床意义.方法对406例系统性红斑狼疮(SLE)患者(其中LN 122例)和74例其他自身免疫病患者及120例健康体检者采用间接免疫荧光法测定ANA,应用欧蒙印迹法测定ANA系列.结果 SLE患者ANA阳性率为94.49%,其他自身免疫病组ANA阳...     

年龄、职业和免疫因素与系统性红斑狼疮及狼疮性肾炎的关系

目的评价年龄、职业和免疫冈素与系统性红斑狼疮及狼疮性。肾炎的关系。方法收集2009年本院风湿免疫科住院的172例系统性红斑狼疮患者,将病人分为狼疮性肾炎和非狼疮性肾炎组,分析两组病人的年龄分布情况,并对这两组病人的抗核抗体（ANA）、抗ENA抗体和补体C3、C4进行检测。结果本研究的系统性红斑狼疮病人中,农民患者人数最多,占38．3％;狼疮性肾炎和非狼疮性肾炎组患者的年龄分布一致,均主要集中存15～44年龄段;两组患者的核型和15种抗体的阳性率没有统计学差异;狼疮性肾炎和非狼疮性肾炎组的C3与C4值均具有正相关的趋势（相关系数为0．85）,并且狼疮性肾炎组病人的C3值明显低于非狼疮性肾炎组（P=0．03）。结论性别、年龄、工作生活环境及ANA、C3、C4对系统性红斑狼疮的诊断具有很大的价值,其中补体c3对评价系统性红斑狼疮和狼疮性肾炎有较大的意义。     

抗磷脂抗体与狼疮性肾炎的相关性研究北大核心CSCD

目的:探讨抗心磷脂抗体(aCL)IgG、IgM、抗β2-糖蛋白1(β2-GP1)抗体IgG、IgM及其他指标与狼疮性肾炎(LN)和系统性红斑狼疮(SLE)的相关性。方法:检测LN及无肾脏累及的SLE患者aCL(IgG、IgM)、抗β2-GP1抗体(IgG、IgM)、C3、C4、抗ds-DNA抗体、肌酐、尿蛋白等指标,判断其与LN和SLE疾病相关程度。结果:LN组与无肾脏累及的SLE组患者肌酐、尿蛋白定量和IgG型抗β2-GP1差异有统计学意义(P=0.005、P=0.000、P=0.003);IgG、IgM型aCL、IgM型抗β2-GP1抗体阳性率、抗ds-DNA抗体、C3、C4水平差异无统计学意义(P>0.05)。进一步对SLEDAI评分分组,LN组IgG型aCL(P=0.048,r=0.318)与LN疾病活动呈弱正相关,而C3(P=0.005,r=-0.439)与LN疾病活动呈中等程度的负相关;LN组IgM型aCL、IgG、IgM型抗β2-GP1抗体浓度、尿蛋白定量、抗ds-DNA抗体、C4、肌酐水平与疾病活动程度无相关性(P>0.05)。无肾脏累及的SLE组以上各项指标与疾病活动程度均无相关性(P>0.05)。结论:LN患者血清中C3、IgG型aCL与疾病进展相关,可作为LN疾病诊治过程中的辅助诊断指标。     

四种自身抗体联检对SLE诊断的临床价值

目的：探讨抗核抗体（ANA）、抗双链DNA（ds-DNA）抗体、抗Sm抗体和抗核糖体P蛋白（r-RNP）抗体联检对系统性红斑狼疮（SLE）诊断的临床价值。方法：检测49例SLE患者、33例其他结缔组织病患者（对照组）和40名正常人血清ANA、抗ds-DNA抗体、抗Sm抗体和抗r-RNP抗体。结果：ANA、抗ds-DNA抗体、抗Sm抗体和抗r-RNP抗体在SLE患者中的阳性率明显高于对照组和正常人组（P〈0.01）;ANA与抗ds-DNA抗体的敏感性显著高于其他两种自身抗体（P〈0.05）;SLE活动期患者与非活动期患者抗ds-DNA抗体阳性率有显著性差别（P〈0.01）;抗ds-DNA抗体滴度与SLE-DAI呈正相关（r=0.57,P〈0.01）;ANA、抗ds-DNA抗体、抗Sm抗体和抗r-RNP抗体联检的敏感性可达98.0%。结论：自身抗体联检提高了SLE诊断的敏感性,对SLE的诊断和治疗有重要意义。     

抗C1q抗体与狼疮性肾炎肾脏的病理学关系

目的探讨抗C1q抗体与狼疮性肾炎(lupus nephritis,LN)肾脏病理的关系。方法采用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)对46例LN患者血清抗Clq抗体滴度进行检测,分析抗Clq抗体与病理表现(Austin肾脏病理评分和Banff肾小管病变TIL评分)间的关系。结果抗C1q抗体在LN病理活动患者中阳性率为42.9%。抗Clq抗体与Austin肾脏病理评分CI呈负相关(r=-0.315,P<0.05);与Banff肾小管病变TIL病理评分的I值、L值呈负相关(r=-0.321,P=0.046;r=-0.397,P=0.012),抗Clq抗体与肾小球硬化率呈负相关(r=-0.335,P=0.023)。抗C1q抗体在各病理类型中的分布,差异无统计学意义。结论抗C1q抗体阳性率与LN肾脏间质损伤程度有关。     

血清抗C1q抗体在系统性红斑狼疮疾病活动性判断及狼疮肾炎诊断中的价值

目的探讨抗C1q抗体(C1qAb)在系统性红斑狼疮(SLE)活动性及狼疮肾炎(LN)诊断和疾病活动性判断中的价值。方法采用酶联免疫吸附法检测SLE患者(n=89)、疾病对照组(n=56)和正常对照组(n=42)血清中的抗C1q抗体阳性率,并与SLE患者临床实验室指标﹑活动性评分进行分析。结果 C1qAb的阳性率在SLE患者中显著高于疾病对照组和正常对照组患者(P<0.05);C1qAb阳性的SLE患者肾损发生率、活动性狼疮发生率及抗dsDNA抗体的阳性率均高于C1qAb阴性患者(P<0.05);C1qAb与SLEDAI活动性评分、抗核小体抗体(anti-nucleosome antibody,AnuA)及抗dsDNA抗体呈正相关(P<0.05)。结论抗C1q抗体对SLE的诊断和疾病活动性判断有重要价值;抗C1q抗体参与了SLE肾脏损害的发病机制。     

Anti-neutrophil Cytoplasmic Antibodies in New-onset Systemic Lupus Erythematosus and Lupus Nephritis

This study aims to investigate the role of Antineutrophil cytoplasmic antibodies (ANCA) in patients with new-onset systemic lupus erythematosus (SLE). Sixty SLE patients, 28 of whom had lupus nephritis (LN), and 60 normal controls were enrolled; Serum ANCA was measured by enzyme linked immunosorbent assay (ELISA). The clinical and laboratory parameters of the patients were also recorded. Results show that twenty SLE patients were seropositive for ANCA, which was significantly higher than in normal controls. LN patients had significantly higher positive rate of ANCA than patients without nephritis. Compared with ANCA-negative patients, the ANCA-positive patients had significantly higher incidence of nerves system disorder, myocarditis, renal involvement and serositis. The positive rate of gamma-globulin, anti-dsDNA and anti-Sm antibodies were significantly higher in ANCA-positive patients. Elevated IgG and ESR, decreased serum C3/C4 appeared more often in ANCA-positive patients. In addition, serum ANCA level correlated positively with disease activity. Taken together, ANCA might be used as a potential complementary parameter to differentiate LN from SLE without nephritis. In addition, ANCA may serve as a useful marker of the disease activity of SLE.     

Simultaneous Positivity for Anti-DNA, Anti-Nucleosome and Anti-Histone Antibodies is a Marker for More Severe Lupus Nephritis

Objective

The purpose of this study is to examine autoantibody profile of systemic lupus erythematosus (SLE) patients with lupus nephritis (LN) and to establish the correlation between the antibody reactivity and disease activity of LN.

Methods

Autoantibodies and serological parameters were measured and analyzed in 589 SLE patients. The associations of the co-positivity of anti-dsDNA, -nucleosome and –histone antibodies (3-pos) with clinical, serological and outcome parameters were analyzed.

Results

At the study entry, the prevalence for anti-dsDNA (61.52 % vs. 34.11 %, P?<?0.0001), anti-nucleosome (56.09 % vs. 37.21 %, P?=?0.0002) and anti-histone (49.35 % vs. 33.33 %, P?=?0.0013) antibodies in patients with LN were significantly higher than that in patients without LN. Patients with 3-pos had a higher proportion of proliferative renal lesions (class III?+?IV). The incidence of a poor renal outcome (7.14 % vs. 2.52 %, P?=?0.0174) in LN patients with 3-pos was significantly higher than those without 3-pos. Moreover, the rate of remission (73.63 % vs. 82.37 %, P?=?0.0245) was significantly reduced and recurrence increased (58.90 % vs. 23.44 %, P?<?0.0001) in 3-pos patients as compared to that in non 3-pos within the LN group.

Conclusion

Our data indicate a strong association between the 3-pos and renal disease activities, especially proliferative glomerulonephritis. The ability of 3-pos to predict renal flares may lead to major additional benefits in the follow-up of these patients.     

Pathogenesis and significance of glomerular C4d deposition in lupus nephritis: activation of classical and lectin pathways

Immune complex-mediated complement activation through the classic pathway plays a key role in the pathogenesis of lupus nephritis (LN). C4d deposition in renal tissue reflects the prognosis of systemic lupus erythematosus (SLE). The aim of the current study is to investigate the pathogenesis and clinicopathologic significance of glomerular C4d deposition in LN. We retrospectively analyzed clinical and histopathological data of 20 SLE patients with renal biopsy-proven LN and 10 non-SLE renal biopsy samples as control. LN biopsies showed varying degrees of glomerular C4d staining associated with immune complex deposits, IgG (p = 0.015), C1q (p = 0.032) and C3 (p = 0.049). 7 LN biopsies had all of C4d, C1q and C3 deposits in their glomeruli, indicative of the activation of the classical pathway, whereas 2 LN biopsies had C4d and C3 deposits without accompanying C1q deposits, indicating the activation of the lectin pathway. Glomerular C4d deposition was correlated with the LN subtype (p < 0.001). In particular, a diffusely intense and coarsely granular pattern of C4d deposition in all glomeruli was detected in class V membranous LN. However, glomerular C4d deposition was correlated with neither disease activity of SLE nor histological activity and chronicity of LN. In conclusion, the activation of the lectin pathway as well as the classical pathway seems to play a crucial role in the pathogenesis of LN. Glomerular C4d staining could be helpful for diagnosing class V membranous LN, although glomerular C4d deposition does not reflect SLE disease activity and histological activity and chronicity.     

Association of angiotensin-converting enzyme polymorphisms with systemic lupus erythematosus and nephritis: analysis of 644 SLE families

Angiotensin II is a strong candidate for the perpetuation of autoimmunity, nephritis and visceral damage in systemic lupus erythematosus (SLE). Our goal was to determine whether angiotensin-converting enzyme (ACE) gene polymorphisms are associated with SLE and/or lupus nephritis (LN). We genotyped 644 SLE patients and 1130 family members for three ACE gene polymorphisms: Alu insertion/deletion (I/D), 23949 (CT)(2/3) and 10698 (G)(3/4). All patients met the American College of Rheumatology (ACR) criteria for SLE, and all LN patients met ACR renal criteria and/or had biopsy evidence of LN. We used the transmission/disequilibrium test (TDT) to examine associations between each polymorphism and SLE, including Caucasian, non-Caucasian, and LN subgroups. We also examined transmission of haplotypes defined by these polymorphisms. The ACE I/D polymorphism was associated with SLE among non-Caucasians (61% transmission, P = 0.026) and the 23949 (CT)(2/3) polymorphism was associated with LN among non-Caucasians (69% transmission, P = 0.014). Several haplotypes defined by these 2 markers demonstrated strikingly increased transmission among non-Caucasians (81% - 66% transmission, P = 0.0046 to 0.010). Due to the choice of study design and analytic method these results are unlikely to be due to population admixture. Our findings suggest that DNA sequence variation in the ACE gene influences the risk of developing SLE and LN.     

Autoantibodies against monomeric C-reactive protein in sera from patients with lupus nephritis are associated with disease activity and renal tubulointerstitial lesions

Serum levels of C-reactive protein (CRP) often remain low despite high disease activity in systemic lupus erythematosus (SLE). Sera from 96 patients with renal biopsy-proven active lupus nephritis, 24 of 96 patients in remission, and 49 patients with SLE with negative urinalysis (nonrenal SLE) was collected. Immunoglobulin G autoantibodies against monomeric CRP (mCRP) were screened by enzyme-linked immunosorbent assay with purified human CRP. Associations with clinical features, pathological data, and laboratory findings were investigated. The prevalence of mCRP autoantibodies in active lupus nephritis (57/96, 59.4%) was significantly higher than that in patients with SLE without clinical evidence of kidney involvement (20/49, 40.8%, p = 0.034). For the 13 patients with positive mCRP autoantibodies and sequential sera, their positive mCRP autoantibodies in active phase turned negative in remission (13/13, 100%). Patients with mCRP autoantibodies had significantly higher SLEDAI scores than patients without mCRP autoantibodies (18.3 +/- 5.2 vs 15.8 +/- 4.0, p = 0.013), who were more likely to experience acute renal failure (14/55 vs 2/33, p = 0.022), oral ulcer (15/57 vs 3/39, p = 0.022), and delayed activated partial thromboplastin time (18/52 vs 2/38, p = 0.001). Positive correlations between levels of mCRP autoantibodies and semiquantitative scores of renal histologic features were first observed in lupus nephritis as follows: interstitial inflammation (r = 0.328), tubular atrophy(r = 0.276), interstitial fibrosis (r = 0.211), and chronicity index score (r = 0.243). Autoantibodies against mCRP are prevalent in patients with lupus nephritis and are associated with disease activity and renal tubulointerstitial lesions.