抗核小体抗体诊断系统性红斑狼疮的价值

280份血清,取自健康体检者50例，类风湿关节炎（RA）74例，系统性红斑狼疮（SLE）106例．其他结缔组织病50例．分别检测其抗核抗体（ANA），抗双链DNA（dsDNA），抗史密斯（Sm），抗组蛋白（His）及抗核小体抗体（AnuA）抗体。结果5种抗体诊断SLE的敏感性和特异性为；ANA96．2%、31％，AnuA80．1％、93％，dsDNA56．6%、92％，Sm49．7％、90％，His54．7％、85%。ANA、AnuA敏感性明显高于其他3种抗体（P〈0．001）．AnuA、dsDNA、HiS、Sm的特异性明显高于ANA（P〈0．001）。AnuA是SLE的又一种特异性抗体，其与ANA、dsDNA抗体及Sm抗体、His抗体联合检测对SLE的诊断有重要意义。     

抗细胞膜DNA自身抗体快速检测系统性红斑狼疮

目的 探讨抗细胞膜DNA自身抗体（mDNA)在系统性红斑狼疮患者的表达以及这种特异抗体与抗dsDNA抗体的不同。方法 用间接免疫荧光法观察培养的HL60细胞的特异性细胞膜的荧光图形。结果 抗细胞膜DNA自身抗体在SLE患者90例中有81例阳性（阳性率90％）,而在类风湿关节炎（RA）患者35例,强直性脊柱炎（AS）患者31例和健康献血员42名中均为阴性,在干燥综合征（SS）患者20例中有1例阳性（阳性率5％）,抗细胞膜DNA自身抗体对SLE诊断的特异性为98．8％。结论 抗细胞膜DNA自身抗体是一种诊断。SLE的新的标记抗体,其敏感性高（90．0％）,特异性强（98．8％）,较抗dsDNA抗体、抗Sm抗体检测更先进。     

系统性红斑狼疮患者血清抗核小体抗体检测分析

目的探讨血清抗核小体抗体（ANuA）的检测在系统性红斑狼疮（SLE）患者中的意义。方法采用免疫印迹法检测58例SLE患者及40例健康人血清抗核小体抗体。结果SLE患者血清ANuA阳性率为74．1％。SLE患者与健康对照组血清中ANuA阳性率差异具有极显著性（P〈0．001）。SLE活动期患者与非活动期患者ANuA阳性率差异有极显著性（P〈0．001）。结论ANuA可以作为抗dsDNA和抗Sm以外的诊断SLE和判断SLE活动期的一种新的自身抗体。     

系统性红斑狼疮血清抗核小体抗体水平及意义的探讨

目的 研究抗核小体抗体(AnuA)在系统性红斑狼疮(systemic lupus erythematosus，SLE)患者血清中的水平及其相关影响因素，探讨AnuA在SLE诊治中的作用和意义。方法 采用酶联免疫吸附法(EUSA)测定120例初诊SLE患者、55例其他风湿性疾病和30名健康对照血清中AnuA水平。同时记录各种临床表现，检测并分析其治疗前的其他自身抗体和实验室指标。结果 自身抗体在SLE及其他风湿病对照组的阳性率分别为AnuA56％和7％，抗dsDNA抗体35％和1％，抗Sm抗体24％和0。AnuA与SLE患者性别、年龄、病程无相关性，对sLE的诊断敏感性和特异性分别为55．8％、9513％，对狼疮肾炎(1upus nephritis，LN)的诊断敏感性和特异性分别为77．％、64．5%。AnuA与肝脏损害和疾病活动呈线性相关(t=3．152，2．171，P＜O．05)。AnuA分别与抗dsDNA、抗Sm联合检测对SLE诊断敏感性提高27％、40％（X^2值分别为38．930、18．161，P＜O．01)。结论AnuA在SLE血清中水平显著增高，AnuA测定是SLE诊断和治疗监测中有价值的新的实验室检测指标之一，与抗dsDNA抗体联合检测可提高诊断SLE、LN的敏感性和特异性。     

自身抗体联合检测在系统性红斑狼疮诊断中的意义

目的研究抗细胞膜DNA(cmDNA)抗体、抗核小体抗体(AnuA)、抗脱氧核糖核蛋白(DNP)抗体及抗双链DNA(dsDNA)抗体等特异性抗体在系统性红斑狼疮(SLE)诊断中的意义,并与抗核抗体(ANA)的敏感性和特异性进行比较。了解特异性自身抗体联合检测在SLE的诊断及临床应用中的意义。方法测定了125例SLE及118例疾病对照组(包括原发性干燥综合征、多发肌炎、系统性硬化症、未分化结缔组织病、类风湿关节炎、骨关节炎、强直性脊柱炎及银屑病关节炎)患者血清中的自身抗体。利用间接免疫荧光法测定抗cmDNA抗体和ANA,酶联免疫吸附试验(ELISA)测定AnuA、乳凝法检测抗DNP抗体、金标法测定抗dsDNA抗体。结果AnuA、抗cmDNA抗体、抗DNP抗体、抗dsDNA抗体和ANA在SLE患者中的阳性率分别为68%、38.4%、51.2%、49.6%和95.2%,均明显高于疾病对照组(3.4%、4.2%、1.7%、0.8%和25.4%),差异有统计学意义(P<0.001)。ANA与AnuA的敏感性显著高于其他三种抗体,差异有统计学意义(P<0.05);AnuA、抗cmDNA抗体、抗DNP抗体、抗dsDNA抗体和ANA的特异性分别为95.8%、96.6%、98.3%、99.2%和74.6%;AnuA在抗DNP抗体、抗dsDNA抗体阴性的SLE中的阳性率明显高于其他抗体(P<0.05);自身抗体的联合检测可提高SLE诊断的敏感性,但特异性无明显改变。结论抗cmDNA抗     

抗细胞膜DNA抗体检测方法的建立及对系统性红斑狼疮诊断价值的临床应用研究

目的 应用间接免疫荧光法(IIF)检测抗细胞膜DNA(cmDNA)抗体,探讨抗cmDNA抗体对系统性红斑狼疮(SLE)的诊断价值.比较以人B淋巴细胞株Raji、人早幼粒白血病细胞株HL60为底物,抗cmDNA抗体在SLE中的检测效果.方法 选取306例SLE患者,192例非SLE疾病对照组,包括脊柱关节病(SPA) 52例,类风湿关节炎(RA) 70例,原发干燥综合征(pSS) 30例,其他结缔组织病(CTD)40例.50名健康志愿者作为对照组.采用IIF法观察培养的人B淋巴细胞株Raji、人早幼粒白血病细胞株HL60的细胞膜的荧光图形;用IIF法检测抗核抗体、抗双链DNA(dsDNA)抗体;联合应用免疫双扩散法和蛋白印迹法检测抗Sm抗体,酶联免疫吸附试验(ELISA)法测定抗核小体抗体(AnuA).配对资料比较用McNemarX2检验,相关性分析采用Spearman相关及Logistic回归分析.结果以Raji及HL60 2种细胞株为底物检测SLE患者抗cmDNA抗体,敏感性分别为72.5％、76.1％,特异性分别为91.7％、86.8％,差异均无统计学意义(P＞0.05).抗cmDNA抗体的敏感性明显高于抗Sm抗体及抗dsDNA抗体,差异有统计学意义(P＜0.01);特异性与抗dsDNA抗体相似(P＞0.05),日低于抗Sm抗体及AnuA(P＜0.01).抗cmDNA抗体分别与抗dsDNA抗体、抗Sm抗体及AnuA联合检测在SLE诊断中的敏感性均明显高于上述自身抗体单独检测,差异有统计学意义(P＜0.05).抗cmDNA抗体与SLE患者的黏膜溃疡之间有相关性(OR=2.343,P=0.029).抗cmDNA抗体与红细胞沉降率(ESR)有相关性(OR=1.031,P=0.012).抗cmDNA抗体与SLE疾病活动指数(SLEDAI)评分无相关性(r=0.070,P=0.600).本文研究还证实Raji细胞株较HL60细胞株更易复苏、荧光图形亮度更强,表达效果更好.结论 抗cmDNA抗体对SLE诊断的敏感性高,特异性强,可能成为SLE诊断的相对特异性抗体之一.抗cmDNA抗体与抗dsDNA抗体、抗Sm抗体及AnuA联合检测可提高对SLE诊断的敏感性.选择Raji细胞株为底物检测抗cmDNA抗体较HL60细胞株更有优势.     

抗核小体抗体与抗C1q抗体在狼疮肾炎血清的表达及其临床意义

目的探讨抗核小体抗体与抗C1q抗体在狼疮肾炎（lupus nephritis，LN）患者血清的表达及其临床意义。方法使用酶联免疫吸附试验（ELISA）对46例LN患者血清进行检测，并与31例无肾炎临床表现的SLE患者作对照。结果LN患者血清中抗核小体抗体与抗C1q抗体浓度及阳性率显著高于SLE对照组（P〈0．01）。抗双链DNA（dsDNA）抗体、抗Sm抗体、抗nRNP抗体、抗心磷脂（aCL）IgG抗体有较高的阳性率，与对照组相比差异有统计学意义（P〈0．05）。将抗核小体抗体、抗C1q抗体、抗dsDNA抗体、抗Sm抗体、抗nRNP抗体和aCLIgG抗体分别引入Logistic回归进行统计分析，结果显示入选的自变量包括抗核小体抗体、抗C1q抗体、抗dsDNA抗体（P〈0．05）。结论在LN患者中，存在着抗核小体抗体、抗C1q抗体的高表达。抗核小体抗体及抗C1q抗体在LN发病中起重要的作用。抗核小体抗体、抗C1q抗体、抗dsDNA抗体是反映SLE患者并发肾脏损害的重要指标，在LN诊断和判定其活动性方面有重要作用。     

抗细胞膜DNA抗体对系统性红斑狼疮的诊断价值及与其他抗体联合检测的意义

目的 探讨抗细胞膜DNA(mDNA)抗体在系统性红斑狼疮(SLE)患者的表达以及该特异性抗体对SLE患者的诊断价值及与其他抗体联合检测的意义.方法 用间接免疫荧光法观察培养的HL60细胞的特异性细胞膜的荧光图形,以细胞周连续的环状荧光为抗mDNA抗体阳性.同时检测SLE的其他常见抗体,采用pearsonχ~2检验进行统计学处理.结果 抗mDNA抗体在205例SLE患者中有145例阳性,阳性率70.7%,在55例类风湿关节炎(RA)患者中5例阳性,阳性率为9.1%,45例原发性干燥综合征(pSS)患者中10例阳性,阳性率为22.2%,35例皮肌炎/多肌炎(PM/DM)患者中4例阳性,阳性率14.3%,50名健康对照组中均为阴性.抗mDNA抗体对SLE诊断的敏感性为70.7%,特异性为86.7%.抗mDNA抗体阳性+抗核抗体(ANA)阳性联合检测的敏感性94.6%,特异性76.7%;抗mDNA抗体阳性+抗双链DNA(dsDNA)抗体阳性联合检测的敏感性76.8%,特异性95.5%;抗mDNA抗体阳性+抗Sm抗体阳性联合检测的敏感性79.6%,特异性100%;抗mDNA抗体阳性+抗核小体抗体(AnuA)阳性联合检测的敏感性93.0%,特异性100%.结论 抗mDNA抗体是一种诊断SLE的新的标记抗体,其敏感性较高,特异性强,较抗dsDNA抗体、抗Sm抗体检测更先进.与SLE常用其他抗体联合检测可进一步提高敏感性和特异性.     

自身抗体与类风湿因子联合检测在幼年型类风湿关节炎早期诊断中的意义

目的探讨多种自身抗体与类风湿因子（RF）联合检测在幼年型类风湿关节炎早期诊断中的意义。方法选择35例幼年型类风湿关节炎患儿，采用散射比浊法检测血清RF；ELISA方法检测血清抗核抗体、抗双股DNA抗体、抗Sm抗体、抗RNP抗体。结果抗RNP抗体的阳性数最多，RF的阳性数相对比较少，但是5种抗体与对照组相比均有统计学差异（P均〈0．01）。除抗双股DNA抗体、抗Sm抗体的特异性高于其他3项（P〈0．05），其余抗体的敏感性和特异性差异均无统计学意义（P〉0．05）。结论抗核抗体、抗双股DNA抗体、抗Sm抗体、抗RNP抗体和RF联合检测，弥补了单一的抗体与RF对类风湿关节炎诊断的不足，提高了类风湿关节炎的检出率及检测特异性，值得临床推广应用。     

抗瓜氨酸肽抗体谱在幼年类风湿关节炎诊断中的意义

目的探讨抗环瓜氨酸肽抗体（抗CCP抗体）、类风湿因子（RF）、抗核周因子（APF）、抗角蛋白抗体（AKA）对幼年类风湿关节炎（JRA）诊断的意义，并与类风湿关节炎（RA）进行比较。方法分别采用酶联免疫吸附试验（ELISA）、胶乳凝集法、间接免疫荧光法检测54例JRA患者、31例非RA对照组、116例成人RA患者血清中的抗CCP抗体、RF、APF、AKA。结果54例JRA患者抗CCP抗体、RF、APF、AKA的敏感性分别为61．1％、57．4％、37．0％、18．5％，特异性分别为96．8％、93．6％、96．8％、100％。抗CCP抗体与RF在JRA的敏感性差异无统计学意义，但明显高于APF、AKA;4种抗体在JRA的特异性比较差异无统计学意义。RA患者中4种抗体敏感性分别为82．3％、78．3％、48．7％、25．4％，特异性分别为95．7％、7．3．7％、91．6％、94．0％。4种抗体在JRA诊断中的敏感性均明显低于RA组，RF在JRA患者中特异性明显高于RA患者，而其他3种抗体的特异性在两组患者比较差异无统计学意义。结论虽然抗CCP抗体谱在JRA诊断中的敏感性不及RA组，但对JRA的诊断仍具有较好的敏感性和特异性，可用于JRA的诊断。     

Two decades of universal hepatitis B vaccination in taiwan: impact and implication for future strategies

BACKGROUND & AIMS: Following the world's first successful implementation of a universal hepatitis B virus (HBV) vaccination program for infants in Taiwan 20 years ago, we performed this study to evaluate the long-term protection afforded by HBV vaccination and to rationalize further prevention strategies. METHODS: HBV seromarkers, including hepatitis B surface antigen (HBsAg) and antibodies to HBsAg (anti-HBs) and core antigen (anti-HBc), were studied in 18,779 subjects from neonates to adults below 30 years of age in 2004. The birth cohort effect was evaluated by comparing the results of the same birth cohorts at different ages among this survey and the previous 1984, 1989, 1994, and 1999 surveys. RESULTS: The seropositive rates for HBsAg, anti-HBs, and anti-HBc were 1.2%, 50.5%, and 3.7%, respectively, in those born after the vaccination program (<20 years of age) in 2004. A positive maternal HBsAg status was found in 89% of the HBsAg seropositive subjects born after the vaccination program. The absence of an increase in HBsAg seropositive subjects at different ages in the same birth cohorts born after the vaccination program implied no increased risk of persistent HBV infection with aging. CONCLUSIONS: Universal HBV vaccination provides long-term protection up to 20 years, and a universal booster is not indicated for the primary HBV vaccinees before adulthood. Maternal transmission is the primary reason for vaccine failure and is the challenge that needs to be addressed in future vaccination programs. This may include an appropriate hepatitis B immunoglobulin administration strategy for high-risk infants and involve efforts to minimize noncompliance.     

Anti-pre-S antibodies in different groups of patients with hepatitis B virus infection

The anti-pre-S antibody in the samples of sera from normal healthy persons and patients with different clinical types of liver diseases due to hepatitis B virus (HBV) infection was detected by a newly established enzyme-linked immunosorbent assay technique. This test is a blocking assay where anti-pre-S antibody in the patient's serum blocks subsequent addition of horse radish peroxidase-labelled polymerized human serum albumin (pHSA) to the pHSA-receptor site of HBsAg molecules fixed on a solid surface. Anti-pre-S activity was not detected in any from 95 healthy persons who were negative for all HBV-markers or from 105 healthy HBV carriers. In 12 sera from HBV vaccine recipients, anti-pre-S activity was noted in higher proportions compared with anti-HBs, after both the second and third doses of vaccine. Anti-pre-S activity was detected in small proportions of HBsAg positive sera from acute viral hepatitis (4.2%) and chronic active hepatitis (10%). In subacute viral hepatitis patients, the anti-pre-S antibody was totally absent. However, anti-pre-S activity was recorded in high proportions of HBsAg-positive sera from patients with cirrhosis of liver (57.2%) and fulminant hepatitis (41.6%). The anti-pre-S antibodies were assumed to be implicated in the clearance of HBV particles from circulation without causing tissue damage.     

抗CCP抗体和抗Sa抗体联合检测对老年人RA的临床意义

目的探讨抗环瓜氨酸肽抗体（抗CCP抗体）和抗Sa抗体联合检测对老年人类风湿关节炎（RA）的临床意义。方法检测85例老年人RA患者的抗CCP抗体和抗Sa抗体,结合临床资料分析。结果抗CCP抗体和抗Sa抗体对RA诊断敏感性分别为77．6％和32．9％,特异性分别为97．4％和95．4％。抗CCP抗体、抗Sa抗体、类风湿因子（RF）均阳性组医生对病情评估、患者对病情评估、Sharp评分、ESR及CRP水平均较阴性组增高。24例RF阴性老年人RA中,抗CCP抗体、抗Sa抗体阳性率分别为50％、41．7％。结论抗CCP抗体和抗Sa抗体联合检测有助于老年人RA的诊断,且二者与患者病情活动性及严重性相关。     

甲状腺过氧化物酶抗体在自身免疫性甲状腺疾病中的表现

甲状腺功能亢进（甲亢）、甲状腺功能低下（甲低）和亚临床甲低患者甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TGAb）和甲状腺微粒体抗体（TMAb）的阳性率和阳性患者的抗体水平均高于正常对照组，TPOAb阳性率在各组中又明显高于同组的TGAb和TMAb阳性率。甲状腺功能恢复正常的复诊组TPOAb阳性患者的抗体水平明显低于甲亢组、甲低组和亚临床甲低组。提示TPOAb对自身免疫性甲状腺疾病的诊断、治疗及预后评估具有一定的临床意义。     

Cell membrane-specific epitopes on CD30: Potentially superior targets for immunotherapy

Because CD30 is highly expressed on Hodgkin's lymphoma and anaplastic large cell lymphoma, it is a promising target for immunotherapy. Soluble CD30, the extracellular domain of CD30 that is shed from the cells, can reduce the effects of CD30-targeting agents by competitive binding. In this study, we identified two epitopes on membrane-associated CD30 that are missing on soluble CD30 probably because of a conformational change upon shedding. These epitopes are potentially superior targets for immunotherapy because targeting them should be free from the competitive effects of soluble CD30. We studied 27 anti-native CD30 mAbs that were assigned to 8 different topographical epitopes. Soluble CD30 was prepared from culture supernatants of L540 cells or Karpas 299 cells. In an ELISA, the mAbs to two epitopes, Ep2 (amino acids 107-153) and Ep7 (amino acids 282-338), showed less than a 2% average cross-reactivity to soluble CD30 compared with a CD30-Fc fusion protein. In addition, these mAbs bound to CD30 on cells in the presence of an excess of soluble CD30. These epitopes (Ep2 and Ep7) are, therefore, more efficiently presented on cell-associated CD30 than on soluble CD30 (membrane-specific epitopes). Also, soluble CD30 in the sera of mice bearing L540 tumors did not form immune complexes with the membrane-specific mAbs analyzed by size-exclusion chromatography. In contrast, mAbs to the other epitopes reacted with both soluble CD30 and membrane CD30. Our results suggest that it may be possible to find membrane-specific epitopes on other immunotherapy target molecules.     

Antibody markers in the diagnosis of inflammatory bowel disease

Inflammatory bowel disease(IBD), including Crohn's disease and ulcerative colitis, is a chronic intestinal inflammation of unknown etiology. The diagnosis of IBD is based on endoscopic, radiologic and histopathologic criteria. Recently, the search for a noninvasive marker that could augment or replace part of this diagnostic process has become a focus of IBD research. In this review, antibody markers, including microbial antibodies, autoantibodies and peptide antibodies, will be described, focusing on their common features. At present, no single marker with qualities that are satisfactory for the diagnosis and treatment of IBD has been identified, although panels of some antibodies are being evaluated with keen interest. The discovery of novel IBD-specific and sensitive markers is anticipated. Such markers could minimize the use of endoscopic and radiologic examinations and could enable clinicians to implement individualized treatment plans designed to improve the long-term prognosis of patients with IBD.     

抗核小体抗体检测在系统性红斑狼疮中的临床价值

目的评价抗核小体抗体（ANuA）对系统性红斑狼疮（SLE）的诊断价值。方法检测216例SLE患者和150例非SLE风湿病患者的血清ANuA、抗双链DNA（ds—DNA）抗体、C3、C4、血沉（ESR）水平,评估SLE患者24小时尿蛋白定量及病情活动程度。利用ROC曲线、四格表、多因素秩和检验、多因素相关分析评价ANuA对SLE的诊断价值。结果ANuA诊断SLE的灵敏度和特异度分别为57．4％和98．0％。SLE活动组的ANuA水平明显高于SLE稳定组和非SLE风湿病组;肾脏受累的SLE患者体内的ANuA水平明显高于无肾脏受累者及非SLE风湿病组。ANuA与抗ds—DNA抗体、SLEDAI评分呈正相关,与补体C3、C4呈负相关。结论ANuA对于SLE的诊断价值与抗ds—DNA抗体相似;在中低度活动的SLE患者中其诊断价值明显高于抗ds—DNA抗体;在抗ds—DNA抗体阴性的情况下,ANuA水平的升高有助于SLE诊断的确立;SLE患者体内ANuA水平可作为判断病情活动的指标之一。     

Epidemiology of primary biliary cirrhosis in Victoria, Australia: high prevalence in migrant populations

BACKGROUND & AIMS: The prevalence of primary biliary cirrhosis (PBC) reported in different countries varies widely, indicating that genetic or environmental factors may be important in the etiology of the disease. The aim of this study was to examine this issue further by determining the overall prevalence of PBC in one state in Australia and to examine the prevalence among different migrant groups within this population. METHODS: Thorough case-finding methods were used to identify all cases of PBC in Victoria, Australia. Age-adjusted prevalence rates among different migrant groups were examined. RESULTS: A total of 249 cases were identified, giving a prevalence of 51 cases per million. This is significantly higher than the rate documented in a 1991 Victorian study. Prevalence in the 3 largest migrant groups was greater than that of Victoria as a whole (141, 200, and 208 cases per million in British, Italian, and Greek migrants, respectively). In women older than 40 years, previous studies have documented a prevalence of 940 cases per million in women in the United Kingdom; however, the prevalence was 344 cases per million in British-born immigrants to Victoria and 160 cases per million in Australian-born women. CONCLUSIONS: The current prevalence of PBC in Victoria is higher than previously reported, but the age-adjusted prevalence in those born in Victoria remains significantly lower than in the United Kingdom and is less than in migrant communities. These findings suggest that Victorians may be relatively protected from developing the disease and add further weight to the suggestion that environmental factors may play a role in the etiology of PBC.     

Influence of infection on malaria‐specific antibody dynamics in a cohort exposed to intense malaria transmission in northern Uganda

The role of submicroscopic infections in modulating malaria antibody responses is poorly understood and requires longitudinal studies. A cohort of 249 children ≤5 years of age, 126 children between 6 and 10 years and 134 adults ≥20 years was recruited in an area of intense malaria transmission in Apac, Uganda and treated with artemether/lumefantrine at enrolment. Parasite carriage was determined at enrolment and after 6 and 16 weeks using microscopy and PCR. Antibody prevalence and titres to circumsporozoite protein, apical membrane antigen‐1 (AMA‐1), merozoite surface protein‐1 (MSP‐1₁₉), merozoite surface protein‐2 (MSP‐2) and Anopheles gambiae salivary gland protein 6 (gSG6) were determined by ELISA. Plasmodium falciparum infections were detected in 38·1% (194/509) of the individuals by microscopy and in 57·1% (284/493) of the individuals by PCR at enrolment. Antibody prevalence and titre against AMA‐1, MSP‐1₁₉, MSP‐2 and gSG6 were related to concurrent (sub‐)microscopic parasitaemia. Responses were stable in children who were continuously infected with malaria parasites but declined in children who were never parasitaemic during the study or were not re‐infected after treatment. These findings indicate that continued malaria infections are required to maintain antibody titres in an area of intense malaria transmission.