系统性红斑狼疮患者自身抗体联合检测的临床意义

目的：探讨3种抗体联合检测诊断系统性红斑狼疮（SLE）的临床意义。方法选择2012年1月至2014年1月本院收治的SLE患者60例（SLE组）,以同期于本院体检健康者60例作为对照组。采用酶联免疫吸附法检测抗双链DNA（dsDNA）抗体,采用免疫印迹法检测抗核小体抗体（AnuA）、抗Sm抗体,比较3种抗体单独检测及联合检测的诊断效能。结果 SLE组AnuA、抗Sm抗体、抗dsDNA抗体及3种抗体联合检测阳性率分别为93．3％、33．3％、46．7％、96．7％,均高于对照组检测结果（ P＜0．05）。3种抗体联合检测具有更高的S L E诊断效能。结论 AnuA、抗ds-DNA抗体、抗Sm抗体联合检测有助于避免SLE的漏诊,从而达到早期诊断、治疗的目的。     

系统性红斑狼疮患者多种自身抗体联合检测的临床意义

目的探讨血清抗核抗体(ANA)、抗可溶性抗原(ENA)抗体共16项自身抗体联合检测在系统性红斑狼疮(SLE)诊断中的应用价值。方法收集90例SLE患者、90例风湿性疾病患者和90例健康者血清,采用间接免疫荧光法检测ANA,采用蛋白质免疫印迹法检测其他15项抗体。结果 90例SLE患者ANA、抗核糖体核糖蛋白抗体(抗nRNP)、抗Smith抗体(抗Sm)、抗干燥综合征A抗体(抗SSA)、抗Ro-52抗体、抗双链DNA抗体(抗ds-DNA)、抗核小体抗体(AnuA)、组蛋白(AHA)和抗核糖体P蛋白抗体(ARPA)检测阳性率分别为97.8%、56.7%、33.3%、77.8%、70.0%、35.6%、38.9%、33.3%和43.3%,均高于风湿性疾病患者组和健康对照组,差异有统计学意义(P<0.05)。ANA灵敏度、阴性预测值最高,特异性最低。除ANA以外,抗nRNP/Sm、ARPA、AnuA、抗SSA、抗ds-DNA、抗Sm的正确指数均较高。抗Sm、抗ds-DNA、AnuA、ARPA、抗nRNP/Sm特异性及阳性预测值较高,此5种自身抗体具有互补关系。结论 ANA因灵敏度高,特异性低,只适宜作为SLE的筛选指标。抗Sm、抗ds-DNA、AnuA、ARPA、抗nRNP/Sm对SLE具有较高的特异性,与ANA联合检测可互相弥补其缺陷,有利于SLE的诊断和治疗。     

The pathogenesis of systemic lupus erythematosus

Systemic lupus erythematosus is an autoimmune disease that causes inflammation in the tissues of the brain, endothelial cells, gastrointestinal/genitourinary (GI/GU), joints, kidneys, muscles, and skin. Lupus comprises a range of multisystem disorders involving the deposition of aberrant immune complexes into tissues. Inflammation occurs as a result of autoantibodies attacking organ systems. The pathogenesis of systemic lupus erythematosus is presented.     

脑卒中患者ABCA1基因单核苷酸多态性检测的意义

脑卒中是一种严重威胁人类,特别是50岁以上中老年健康的常见脑血管疾病。研究血脂调节基因将对脑卒中的防治有重要意义。ABCA1基因在调节血浆HDL及细胞内胆固醇水平起关键作用,其单核苷酸多态性（single nucleotide polymorphisms,SNPs）对其功能有不同的影响。     

Lamin B autoantibodies in sera of certain patients with systemic lupus erythematosus

Sera from four patients with systemic lupus erythematosus containing antibodies that yield nuclear rim staining of HEp-2 cells by indirect immunofluorescence were identified and characterized. Each serum contained autoantibodies reacting strongly with lamin B on western blots. One of the four sera displayed weaker reactivity with lamins A and C, while the other three displayed only minimal reactivity with lamins A and C. Titers of antilamin antibodies ranged from 1:1,250 to 1:36,250. Two of the sera also reacted at a dilution of 1:20 with cytoplasmic filaments of PTK-2 cells, suggesting that a small fraction of the autoantibodies in these sera may bind to alpha-helical domains of the lamins that are homologous to those of intermediate filaments. The majority of the antilamin antibodies in these patients' sera are specific for portions of the lamin B molecule that are not homologous to lamins A and C, however. The findings suggest that autoantibodies to the nuclear lamina may, in some instances, be responsible for a rim pattern in the fluorescent antinuclear antibody assay. In addition, autoantibodies to the nuclear lamina in sera of certain patients with systemic lupus erythematosus may be useful for defining the molecular structure and biological functions of lamin B, as well as for studying mechanisms of autoimmunity.     

抗染色质抗体检测在SLE诊断及病情发展中的意义

目的检测SLE患者血清中抗染色质抗体(anti-chromatin antibody,AchA)水平,评价其在SLE诊断和病情发展中的意义。方法选取SLE患者154例,疾病对照组155例(类风湿关节炎46例,干燥综合征49例,骨关节炎10例,系统性硬化症20例,肾病综合征30例),健康人对照107名。用ELISA检测AchA水平,并探讨其与SLE患者发病年龄、病程、疾病活动指数(SLEDAI)评分、其他自身抗体、补体、免疫球蛋白(IgG)、ESR、24 h尿蛋白、肾功能指标等的关系。结果 SLE患者血清中AchA的阳性率为63.6%(98/154),明显高于疾病对照组5.8%(9/155)及健康人对照组0%(P均0.01)。AchA诊断SLE的特异性为96.6%,敏感性为63.6%,阳性预测值和阴性预测值分别为91.6%和81.9%。SLE患者血清中AchA水平明显高于疾病对照组和健康人对照组(P均0.000 1)。与AchA阴性SLE患者比较,AchA阳性SLE患者SLEDAI评分、24 h尿蛋白水平、ESR升高,C3、C4、WBC降低,抗核小体抗体(AnuA)、抗dsDNA抗体、抗核糖体P蛋白抗体水平升高(P均0.05)。相关性分析显示,AchA水平与ESR(r=0.218,P=0.01)、C3(r=0.451,P0.000 1)、Alb(r=0.295,P0.000 1)、AnuA(r=0.349,P0.000 1)、抗dsDNA抗体(r=0.311,P0.000 1)、24 h尿蛋白(r=0.243,P=0.003)、SLEDAI评分(r=0.202,P=0.015)均具有相关性。结论 AchA对SLE的诊断具有较高的敏感性和特异性,并且与疾病活动及病情严重程度相关,与狼疮肾损害强相关,提示其在狼疮肾发病及病理过程中的重要作用。     

维吾尔族系统性红斑狼疮患者自身抗体特点分析

目的探讨新疆维吾尔族（维族）系统性红斑狼疮（systemic lupus erythematosus,SLE）患者血清自身抗体及抗核抗体（antinuclear antibodies,ANA）滴度特征。方法35例维族SLE患者（维族组）和42例汉族SLE患者（汉族组）采用间接免疫荧光法检测血清ANA阳性率及其滴度,采用免疫印迹法检测抗dsDNA、抗Sm、抗SSA及抗SSB及抗RNP抗体阳性率。结果2组血清ANA阳性率均为100％;维族组抗dsDNA阳性率（80．0％）高于汉族组（54．8％）（P〈0．05）;2组抗Sm、抗SSA、抗SSB及抗RNP抗体阳性率比较差异均无统计学意义（P〉0．05）;维族组ANA滴度〉1：1000者占88．5％,与汉族组（81．0％）比较差异无统计学意义（P〉0．05）。结论维族SLE患者血清自身抗体中ANA最常见,抗dsDNA抗体可做为该人群SLE诊断的血清学指标之一。     

系统性红斑狼疮骨髓受累机制初步研究

目的 初步探讨系统性红斑狼疮(SLE)骨髓受累的可能机制.方法 对21例初治SEE患者骨髓标本21份,10例正常对照骨髓标本分别进行骨髓单个核细胞(BMMNC)Coombs试验并采用甲基纤维素法检测CFU-E、CFU-GM、BFU-E产率.结果 10份正常对照骨髓标本BMMNC-Coombs试验均为阴性,21例SLE患者,有12例(57.1%)阳性,其中17例合并血细胞减少者中有10例(58.2%)阳性;4例血细胞正常者中有2例(50.0%)阳性,SLE患者BMMNC-Coombs试验阳性率显著高于正常对照组(P＜0.05).而SLE合并血细胞减少组与血细胞正常组相比,阳性率差异无统计学意义(P＞0.05).BMMNC抗体类型与血细胞水平无显著相关性.SLE合并血细胞减少组的CFU-E、CFU-GM产率与正常对照组相比,差异无统计学意义(P＞0.05).SLE血细胞正常组CFU-E、CFU-GM产率显著高于正常对照组(P＜0.05).SLE患者中,合并血细胞减少组CFU-E、CFU-GM产率显著低于血细胞正常组(P＜0.05).SEE患者无论是否合并血细胞减少其BFU-E产率均显著低于正常对照组(P值均＜0.05).而SLE合并血细胞减少组与血细胞正常组患者相比,其BFU-E产率差异无统计学意义(P＞0.05).结论 SLE患者BMMNC膜表面被覆自身抗体;造血祖细胞增殖、分化功能无明显异常,某些SLE患者可能通过造血祖细胞的代偿增殖维持正常的血细胞水平.     

An in vitro assay for detection of glomerular binding IgG autoantibodies in patients with systemic lupus erythematosus.

The deposition of anti-dsDNA antibodies in the glomerulus is believed to play a critical role in the pathogenesis of nephritis in SLE. However, an absolute correlation between serum levels of anti-dsDNA antibodies and renal disease has not been found. Recently a glomerular binding assay (GBA) has been developed to detect IgG binding to isolated rat glomeruli. We have used the GBA to study sera from four groups of SLE patients: (A) + anti-dsDNA antibodies, active nephritis; (B) - anti-dsDNA antibodies, active nephritis; (C) + anti-dsDNA antibodies, no nephritis; and (D) - anti-dsDNA antibodies, no nephritis. The serum anti-dsDNA antibodies in group A and group C patients could not be distinguished on the basis of isotype, charge, or cross-reactivity with histones. Nevertheless, the mean intensity of glomerular immunofluorescence was significantly higher in group A than in the three other patient groups and distinguished between patients with serum anti-dsDNA antibodies who had nephritis and those without clinically apparent nephritis. GBA reactivity was unaffected by DNase treatment of sera, but was partially inhibited by preincubation with dsDNA. These findings are consistent with the hypothesis that some anti-dsDNA antibodies cross-react with glomerular components and that the presence of this cross-reactivity is associated with, and may be responsible for, the development of nephritis. In addition, we have identified a group of SLE patients with renal disease and typical renal histopathology and immune deposits who do not have serum anti-dsDNA antibodies or antibodies that directly bind to glomeruli in the GBA. The mechanism of renal immune deposition in these patients remains to be determined.     

血清淀粉样蛋白A、C反应蛋白检测对系统性红斑狼疮患者的意义

目的 探讨血清淀粉样蛋白A(SAA)、C反应蛋白(CRP)检测对系统性红斑狼疮(SLE)患者的意义.方法 选取2018年1月至2020年8月入院治疗的89例SLE患者作为SLE组,根据SLE疾病活动指数(SLEDAI)又将SLE患者分为活动组(37例)和稳定组(52例).另外,将60例健康志愿者纳入研究作为对照组.检测纳入研究者SAA、CRP、白细胞计数(WBC)水平,分析组间差异及上述各项指标与SLEDAI的相关性.采用受试者工作特征(ROC)曲线分析检测指标在SLE诊断中的价值.结果 SLE组SAA、CRP水平均高于对照组(P<0.05);活动组SAA、CRP水平均高于稳定组(P<0.05).SLE患者SAA、CRP水平均与SLEDAI呈正相关(r=0.91、0.87,P<0.05).ROC曲线分析显示:用于SLE诊断,SAA的最佳临界值为6.70 mg/L,灵敏度为50.6％,特异度为90.3％,曲线下面积(AUC)为0.742;CRP的最佳临界值为2.12 mg/L,灵敏度为49.4％,特异度为90.3％,AUC为0.673.结论 SLE患者SAA和CRP水平升高,并且与SLEDAI相关,对于评估SLE患者病情有一定的参考价值.     

系统性红斑狼疮患者自身抗检测的临床意义

目的 探讨多项自身抗体检测在系统性红斑狼疮（SLE）诊断中的意义.方法 采用免疫荧光技术测定抗核抗体（ANA）和抗双链DNA抗体（抗ds-DNA）,采用免疫印迹技术测定抗可提取性核抗原抗体（抗-ENA）.结果 83例SLE患者ANA阳性率为93.6%,抗-dsDNA阳性率为67.9%,抗-ENA总阳性率为53.1%,抗-dsDNA和抗-ENA联合检测阳性率为82.3%.结论 自身抗体检测可提高SLE患者的诊断率.     

The clinical significance of autoantibodies to soluble cellular antigens in systemic lupus erythematosus

The relationships between autoantibodies to soluble cellular antigens and clinical features in systemic lupus erythematosus (SLE) were investigated in a large clinical-serological study. The absence of these precipitins in serum was associated with a low prevalence of vasculitis and membranous nephropathy (MGN). Other significant findings were the associations between nRNP antibody and Raynaud's phenomenon and MGN, SSB antibody and sicca complex, PCNA antibody and a young age at onset, and Bu antibody and an old age at onset. However, the most impressive findings were in DA1-positive patients which showed a unique prevalence of photosensitive skin lesions, lymphoadenopathy and hepatosplenomegaly. The present study confirms the usefulness of antibodies to soluble cellular antigens in the classification of patients with SLE.     

巨核细胞增殖与分化障碍在系统性红斑狼疮伴发血小板减少中的作用

目的分析巨核细胞在系统性红斑狼疮（SLE）伴血小板减少中的作用,探讨SLE血小板减少的发病机制。方法根据血小板减少相关实验室指标和骨髓检查结果对176例SLE伴发血小板减少的患者进行分析,并与32例血小板正常的SLE患者对比分析。结果176例SLE患者中有64例（36.4%）伴发血小板减少,其中血小板轻度减少48例（75%）,重度减少16例（25%）。与32例血小板正常的SLE患者对照,伴血小板减少的SLE患者浆膜炎发生率高,肾脏损害程度较重,狼疮病情活动程度更高,补体C3水平在血小板减少组明显低于血小板正常组（P〈0.05）。SLE伴血小板减少者骨髓巨核细胞数量较血小板正常的SLE患者明显减少（P=0.001）,但其中幼稚巨核计数较血小板正常组增多（P=0.019）,而产板巨核细胞计数较血小板正常组患者明显减少（P=0.000）。结论SLE伴发血小板减少多见于活动性病情严重的患者,其巨核细胞数量减少,分化中以幼稚巨核细胞为主,产板型巨核细胞则明显减少,提示巨核祖细胞增殖分化成熟障碍与SLE伴发血小板减少有关。     

系统性红斑狼疮患者血清miR-181a检测的临床意义

目的 研究系统性红斑狼疮（SLE）患者血清miR-181a检测的临床意义.方法 采用反转录PCR法检测了30例SLE患者和30健康个体血清miR-181a,分析了其与患者血沉、C反应蛋白、抗dsDNA抗体和SLEDAI-2K评分等临床特征的关系.结果 SLE患者和健康个体血清miR-181a的相对表达量分别为177（P25~P75：78~354）和41（P25~P75：23~91）,差异具有统计学意义（Z=4.26,P〈0.01）.SLE患者血清miR-181a与血沉、C反应蛋白、抗dsDNA抗体和SLEDAI-2K评分呈正相关,相关系数分别为0.52、0.51、0.63和0.55（P值均小于0.01）.结论 血清miR-181a是评估SLE病情的有益标志物.     

Anti-C1q autoantibodies amplify pathogenic complement activation in systemic lupus erythematosus

Patients with systemic lupus erythematosus (SLE) often develop glomerulonephritis (i.e., inflammation in the glomeruli of the kidney), commonly referred to as lupus nephritis. Patients with lupus nephritis typically have autoantibodies to the complement classical pathway protein C1q. Whether these anti-C1q antibodies play any role in the development of lupus nephritis has been unclear. In this issue of the JCI, a new study demonstrates that anti-C1q antibodies can amplify glomerular injury but only when they are bound within the glomerulus to C1q that has been already brought to that site by other types of glomerular-reactive autoantibodies. These studies are the first, to our knowledge, to provide a causal link between anti-C1q antibodies and target organ damage in SLE.     

Accelerated atherosclerosis in rheumatoid arthritis and systemic lupus erythematosus

It is important for primary care physicians to recognise rheumatoid arthritis and systemic lupus erythematosus patients as high-risk groups for atherosclerosis, requiring aggressive risk-factor modification. Recent studies suggest that this increased risk is not explained by an excess of traditional risk factors, but rather appears to be related to underlying rheumatic disease activity. Moreover, there is emerging data that aggressive treatment with disease-modifying agents may reduce the incidence of atherosclerosis in these conditions.     

系统性红斑狼疮合并血小板减少患者GATA-1基因的表达及其临床意义

目的:探讨系统性红斑狼疮(SLE)合并血小板减少患者骨髓有核细胞GATA-1基因的表达及其临床意义。方法:收集SLE合并血小板减少患者48例,ELISA法检测抗血小板膜糖蛋白GPⅡbⅢ抗体及血小板生生成素受体抗体等血小板相关抗体。实时荧光定量PCR法检测上述抗体阴性SLE合并血小板减少患者8例(血小板减少组)、SLE血小板正常患者10例(病例对照组)及健康志愿者10例(健康对照组)骨髓有核细胞GATA-1 mRNA的表达情况。结果:血小板减少组患者骨髓有核细胞GATA-1 mRNA的表达明显低于病例对照组及健康对照组,3组之间差异具有统计学意义。结论:GATA-1基因转录因子在SLE合并血小板减少患者骨髓有核细胞中表达降低。GATA-1低表达引起造血干细胞成熟分化障碍可能是SLE患者血小板减少的发病机制之一。