抗核小体抗体与儿童系统型红斑狼疮的相关性

目的探讨抗核小体抗体（AnuA）在诊断儿童系统型红斑狼疮（SLE）中的敏感性和特异性，了解AnuA与儿童SLE临床特征、疾病活动性的相关性。方法用Hep-2细胞提取核小体。用酶联免疫吸附方法（ELISA）测定血清中的AnuA，分析AnuA和临床表现的相关性。结果52例SLE中18例AnuA阳性。27例疾病对照组中1例AnuA阳性，30例正常对照组AnuA均为阴性。AnuA在儿童SLE中的敏感性为35％，特异性为96％。AnuA阳性组SLE患儿100％有中枢神经系统损害，AnuA阴性组为47％（x^2=14．57，P〈0．05）。AnuA阳性组SLE患儿100％有肾脏损害，AnuA阴性组为5l％（x^2=13．31，P〈0．05）。AnuA阳性和AnuA阴性的SLE患儿SLEDAI评分高于10分者分别为100％和71％（x^2=6．56，P〈0．05）。结论AnuA对儿童SLE的诊断具有较高的特异性，有助于抗dsDNA抗体、抗心磷脂抗体阴性的儿童SLE的诊断。     

A cross-sectional hospital-based study of autoantibody profile and clinical manifestations of systemic lupus erythematosus in south Indian patients

Our study was aimed to analyze clinical manifestations, autoantibodies and other serological abnormalities in South Indian patients with systemic lupus erythematosus. Clinical history and findings on systemic examination were noted. Antinuclear antibodies (ANA), antibodies to double-stranded DNA (dsDNA) were detected by immunofluorescence and ANA profile by Immunoblotting. Arthritis was most common followed by fever and skin rash. Clinical manifestations vary according to geographical location of the patient. ANA was positive in 64.28% and anti-dsDNA in 89.36% of patients. All patients with lupus nephritis were positive for dsDNA. Detection of antibodies to dsDNA, RNP and anti-Smith (Sm) are of diagnostic and prognostic importance.     

Decreased levels of autoantibodies against apolipoprotein B‐100 antigens are associated with cardiovascular disease in systemic lupus erythematosus

Increased production of autoantibodies is a characteristic feature of systemic lupus erythematosus (SLE) and there is evidence that several of these autoantibodies may contribute to increased cardiovascular disease (CVD) in SLE. Autoantibodies against the apolipoprotein (apo) B‐100 peptides p45 and p210 have been associated with a lower CVD risk in non‐SLE cohorts. The aim of the present study was to investigate how SLE affects the occurrence of these potentially protective autoantibodies. The study cohort consisted of 434 SLE patients and 322 age‐ and sex‐matched population controls. Antibodies against native and malondialdehyde (MDA)‐modified p45 and p210 were measured by enzyme‐linked immunosorbent assay (ELISA). SLE patients had significantly lower levels of p210 immunoglobulin (Ig)G and p45 IgM (both the native and malondialdehyde (MDA)‐modified forms). SLE patients with manifest CVD (myocardial infarction, ischaemic cerebrovascular disease or peripheral vascular disease) had lower levels p210 IgG and p45 IgM than SLE patients without CVD. Decreased levels of these autoantibodies were also observed in SLE patients with permanent organ damage, as assessed by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (ACR) Damage Index (SDI). The present findings show that patients with SLE, a condition generally characterized by abundance of autoantibodies of multiple specificities, have reduced levels of antibodies against the apo B‐100 antigens p45 and p210 and that the levels of these antibodies are reduced further in SLE patients with CVD. These observations suggest the possibility that an impaired antibody‐mediated removal of damaged LDL particles may contribute to the development of vascular complications and organ damage in SLE.     

Variable region sequences of autoantibodies from mice with experimental systemic lupus erythematosus

We have sequenced nine monoclonal antibodies (mAb) derived from C3H.SW mice in which experimental systemic lupus erythematosus (SLE) was induced. The hybridomas were selected for binding to DNA or to HeLa nuclear extract (NE). Three mAb were found to bind DNA, and are shown to exhibit sequence characteristics of pathogenic anti-DNA antibodies. One, mAb 2C4C2, is shown to use a heavy chain V region gene (V_H) identical to the V_H of anti-DNA mAb isolated from other lupus-prone mice, namely (NZB × NZW)F₁. The light chain V region gene (V_L) of mAb 2C4C2 is 98 % homologous to the V_L of another anti-DNA mAb, also isolated from (NZB × NZW)F₁ mice. The other two anti-DNA mAb, 5G12-4 and 5G12-6, share 93 % of their V_H sequences with that of mAb 2C4C2. Six mAb bound proteins of HeLa NE. Four of these six antibodies were found to use the VH124 V_H and V-L7 V_L. The nine mAb use a total of five V_H and four V_L germ-line genes, demonstrating that the autoantibodies induced in mice with experimental SLE do not originate from one B cell clone. Three of these nine V_H and V_L were identical in sequence to germ-line genes, while at least three others had somatic mutations. The latter suggests that the above autoantibodies arise in mice by both usage of existing (pre-immune) B cells, and through an antigen-driven process. Furthermore, it appears that autoantibodies found in mice with experimental SLE use genetic elements similar to those used by mAb that were isolated from mouse strains which develop lupus spontaneously.     

Characterization of anti-endothelial cell antibodies in systemic lupus erythematosus (SLE).

IgG anti-endothelial antibodies (AEA), as measured by ELISA or immunoblotting technique could be detected in serum samples of 56 out of 64 patients with SLE (88%) and mainly occurred in monomeric form. AEA were not cell specific, because the binding reactivity was absorbed partially by both fibroblasts and peripheral blood mononuclear cells. No correlation was found between the presence of AEA and anti-nuclear antibodies. Immunoblotting revealed reactivity of AEA against endothelial antigens ranging in size from 15 to 200 kD. AEA titres were significantly higher in patients with joint or skin abnormalities, compared with patients without these abnormalities. A significant correlation was found between nephritis in SLE and the presence of AEA reactivity against endothelial membrane antigens of 38, 41 and 150 kD. These data show that the pattern of AEA reactivity in serum of SLE patients is heterogeneous, and suggest that AEA against a limited number of antigens may be involved in the pathogenesis of nephritis in SLE.     

Placental pathology in systemic lupus erythematosus with antiphospholipid antibodies

Systemic lupus erythematosus (SLE) is associated with a poor pregnancy outcome. Antiphospholipid antibodies (APL), which include lupus anticoagulant (LAC) and anticardiolipin antibodies (aCL), are frequently found in patients with SLE, and their presence has been associated with fetal loss. To examine placental pathologic features of SLE patients with APL, we performed a pathologic study on 47 placental tissue samples from 47 pregnant SLE patients with APL (15 patients; four LAC single-positive patients, seven aCL single-positive patients, four LAC and aCL double-positive patients) and without APL (32 LAC and aCL double-negative patients). The incidence of extensive infarction, decidual vasculopathy, decidual thrombosis and perivillous fibrinoid change, which have been thought to be characteristic lesions of APL placenta, was significantly higher in the LAC and aCL double-positive patients than in the patients without APL. Conversely, the above-mentioned lesions between the LAC or aCL single-positive patients and the APL negative patients did not differ significantly. Among the 15 patients with APL, two of the three patients with both decidual vasculopathy and thrombosis had extensive infarction associated with fetal death. Moreover, the patients having fetal death showed LAC and aCL double-positivity. In conclusion, this study indicated that the LAC and aCL double-positivity is an important factor for extensive infarction resulting from decidual vasculopathy and decidual thrombosis in the SLE placenta. Moreover, it was indicated that LAC and aCL double-positivity is an important risk factor for fetal death in the SLE patient.     

The clinical utility of anti-ribosomal P autoantibodies in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that can affect multiple organs and thus has a large spectrum of clinical presentations. Assessment of the autoantibody profile is fundamental for the clinical management of SLE patients, providing important data for diagnosis, clinical characterization and disease activity evaluation. Anti-ribosomal P protein (anti-Rib-P, anti-P) antibody, described in the 1980s, is a serological marker for SLE that is present in 13–20% of cases. This reactivity was initially thought to be associated with neuropsychiatric involvement in SLE, with certain conflicting results. Subsequently, associations of anti-Rib-P with liver and renal involvement in lupus were reported. Recently, anti-Rib-P was detected in autoimmune hepatitis patients. Anti-Rib-P reactivity to Trypanosoma cruzi ribosomal target antigens in patients with Chagas heart disease has also been described. This review focuses on the usefulness of the determination of anti-Rib-P in SLE and in other autoimmune and non-autoimmune disorders in clinical practice.     

Atherosclerosis in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease that has a late mortality phase owing mainly to cardiovascular manifestations. Atherosclerosis itself is characterized by inflammatory components, fulfilling the criteria of Witebsky and Rose for an autoimmune disease. SLE patients have increased risk for cardiovascular events, and these are the result of both atherosclerosis and thromboembolic events. Risk factors for atherosclerosis in SLE include “traditional” risk factors (mainly the Framingham risk factors), as well as disease-related factors including disease duration, steroid therapy, and renal disease, and inflammatory mechanisms that specifically contribute to enhanced atherosclerosis in SLE. These include specific antibodies to β2GPI; anticardiolipin antibodies; anti-oxidized low-density lipoprotein; and antibodies to heat shock proteins, complement activation, impaired ability to activate TGF-β1, and elevated levels of CRP. These findings stress the importance of surveillance and preventive strategies to control atherosclerosis in SLE.     

炎性细胞因子在系统性红斑狼疮中的作用

系统性红斑狼疮是一个全身性自身免疫病，常伴多器官受累，许多炎性细胞因子参与了系统性红斑狼疮的发病与发展，该病的活动性及器官损伤程度与不同的细胞因子相关。     

Autoantibodies against neutrophil cytoplasm components in systemic lupus erythematosus and in hydralazine-induced lupus.

Anti-neutrophil cytoplasm antibody (ANCA) has been shown to be no marker of systemic lupus erythematosus (SLE) including lupus nephritis or of progressive systemic sclerosis (PSS). Antibodies against myeloperoxidase (anti-MPO) and elastase, two granulocyte lysosomal enzymes, were found in patients with SLE but not in those with PSS, except for one patient who had anti-MPO. Anti-MPO was present in 21% of patients with SLE, and at low concentrations in about 80% of these cases. Anti-elastase was found in four patients with SLE. In another group of six patients with a SLE-like syndrome induced by anti-hypertensive treatment with the anti-hypertensive hydralazine, anti-MPO antibodies occurred in all six, and anti-elastase antibodies in five. Monitored during a 2-year follow-up period, anti-MPO antibodies were found to persist, whereas anti-elastase antibodies were rapidly eliminated, after withdrawal of the drug.     

Anti-ribosomal ribonucleoprotein autoantibodies in systemic lupus erythematosus

Sera from systemic lupus erythematosus (SLE) patients giving a fluorescent ribosomal pattern on tissue and cell preparations also showed precipitating autoantibodies against purified rat liver ribosomes. Ribosomal antigen is also present in rabbit thymus cellular extract (RTE), since the same sera gave precipitin lines against RTE in identity with ribosomes. Immunofluorescent staining was completely inhibited by serum absorption with ribosomes or with RTE. However ribosomal RNA and RNase or trypsin-treated ribosomes failed to react with these autoantibodies as demonstrated in immunoabsorption and immunodiffusion studies. These data suggest that these sera contain autoantibodies directed against some antigenic site composed of a portion of both RNA and ribosomal protein. Ribosomal autoantibodies were detectable at a low frequency in SLE patients characterized by an active disease and renal involvement.     

Human anti-fibronectin antibodies in systemic lupus erythematosus: occurrence and antigenic specificity.

Sera from patients with connective tissue diseases exhibit autoantibodies to a spectrum of extracellular matrix proteins. Antibodies binding to solid phase bovine fibronectin (Fn) were investigated by ELISA in patients with systemic lupus erythematosus (SLE). Sera showing binding of 2 s.d. above the mean of the normal human control were considered positive and 43/150 SLE sera (28.7%) demonstrated such binding. These antibodies were mainly IgG and IgA as determined by isotype-specific ELISA. Specificity studies on selected positive sera revealed that binding was inhibited by preincubation with soluble Fn, but not with thyroglobulin or type 1 collagen. The binding was demonstrated not to be related to interactions with rheumatoid factor, complement components or immune complexes. Additional studies to determine which Fn fragment is bound by naturally occurring anti-Fn antibodies demonstrated that the binding was predominantly to the 30-kD collagen binding domain (CBD) of Fn molecule. Inhibition studies using 120-kD, 40-kD and 30-kD Fn fragments confirmed that this binding site was the 30-kD CBD.     

系统性红斑狼疮自身抗体研究进展

经化学修饰的组织抗原,与正常组织成分有交叉反应的外来抗原、隔绝的体内自身成分及低分化的组织抗原等在一定条件下可刺激机体组织产生自身抗体.某些自身抗体因对系统性红斑狼疮(SLE)的判断具有高度特异性,已成为诊断SLE的血清指标或特异性抗体,有些自身抗体与疾病的活动性有相关性.因此,测定自身抗体有助于SLE的诊断,并对疾病的活动程度,观察治疗效果,指导临床用药具有重要的临床意义.     

Autoantibodies to histone, DNA and nucleosome antigens in canine systemic lupus erythematosus.

Dogs can develop systemic lupus erythematosus syndromes that are clinically similar to those seen in humans. In contrast, previous observations suggest differences in their autoantibody reactivity patterns against histones and DNA which are components of the nucleosome in chromatin. The objective of this study was to assess comprehensively the levels of autoantibodies against histone, DNA and nucleosome antigens in a population of lupus dogs. The specificities of antibodies in lupus and control dog sera were determined using IgM- and IgG-specific reagents in an ELISA against a variety of chromatin antigens. When compared with control sera, IgG antibodies to individual histones H1, H2A, H3 and H4 were significantly higher in the lupus group. In contrast, we did not detect IgG antibodies specific for H2B, H2A-H2B, DNA, H2A-H2B-DNA or nucleosome in lupus dogs. There was no significant increase in any of the IgM specificities tested. Therefore, the reactivity pattern to nucleosome antigens in canine lupus is restricted to IgG antibodies against individual histones H1, H2A, H3 and H4. This stands in contrast with human and murine lupus, where autoantibodies are directed against a wide variety of nucleosomal determinants, suggesting that unique mechanisms lead to the expansion of anti-histone antibody clones in canine lupus. The high incidence of glomerulonephritis in dog lupus suggests that anti-DNA antibodies are not required for the development of this complication, whereas IgG anti-histone antibodies may be relevant to its pathogenesis.     

Anti-endothelial cell antibodies in systemic vasculitis and systemic lupus erythematosus (SLE): effects of heat inactivation on binding and specificity

Heating sera is used to inactivate complement but may affect the binding characteristics of autoantibodies. We studied the effect of heating sera from patients with systemic vasculitides and SLE on antibody binding to cultured human umbilical vein endothelial cells. Sera from 32 patients with systemic vasculitides, eight with SLE and 10 healthy controls were studied for anti-endothelial cell antibodies (AECA) using an ELISA before and after heating sera to 56 degrees C for 30 min. The median (range) AECA binding index in the patient group increased from 20% (0-153%) to 71.5% (10-259%) (P < 0.0001). The AECA binding index in the control group also increased from 14% (0-52%) to 90% (42-154%) (P < 0.0001). The increased binding was unaffected by the addition of fresh complement or removal of immune complexes and the increased binding after heating persisted even after cooling to 4 degrees C. Specificity experiments showed that after heating, the binding specificity of sera was lost. Removal of immunoglobulin with Protein A abolished the increased binding seen after heating. Heating sera increases AECA binding in both patient and control sera. The mechanism is probably non-specific damage to the immunoglobulin molecule, and heating sera should thus be avoided.     

Detection of anti-RNA antibodies in systemic lupus erythematosus by ELISA using nylon as solid support

A highly sensitive and reproducible enzyme-linked immunosorbent assay (ELISA) for the detection of anti-RNA antibodies is described. The assay procedure involves adsorption of total cellular RNA on nylon beads which could be conveniently stored for a considerable period of time without loss in antigenicity. Sixty-four percent of systemic lupus erythematosus (SLE) sera were positive for anti-RNA antibodies with fluorogenic substrate against 48% with colorigenic substrate.     

系统性红斑狼疮遗传学研究进展

系统性红斑狼疮（systemic lupus erythematosus,SLE)通常被认为是自身免疫疾病的原型，遗传因素在疾病的发生中起重要作用。对狼疮鼠模型的研究已发现约30个基因位点与疾病产生有关，不同位点影响发病的不同环节。人类基因组研究则50个左右基因位点与SLE有关，其中1q23-24,1q41-42,2q37,4p16-15.2,6p21-11及16q13为6个显著相关区域，对特定患者，多个位点不同基因的组合可导致疾病表型的多样性。近期对候选基因的研究进一步证实，遗传因素在决定疾病易感性及临床表型时起作用，不同群体中所涉及的基因或其表达强度均有差异。     

Heterogeneity of binding reactivity to different phospholipids of antibodies from patients with systemic lupus erythematosus (SLE) and with syphilis.

The binding specificities were investigated of anti-phospholipid antibodies derived from sera from 55 patients with SLE and related diseases, and from 33 patients with syphilis. Antibodies from both these groups of patients bind strongly to cardiolipin in solid-phase immunoassays, but only antiphospholipid antibodies from patients with autoimmune diseases are associated with thrombotic complications and recurrent spontaneous abortions. IgG anti-phospholipid antibodies from both groups of patients cross-reacted with a range of negatively charged phospholipids, but binding to neutral phospholipids was largely restricted to sera from patients with syphilis. A monoclonal IgM lambda anti-cardiolipin antibody, derived from a patient with autoimmunity, was used to inhibit binding of anti-phospholipid antibodies to cardiolipin and to phosphatidic acid. This antibody inhibited the binding of autoimmune sera to cardiolipin more strongly than sera from syphilis patients, but the converse pattern of inhibition of binding to phosphatidic acid was observed. The VDRL titre correlated with anti-phospholipid antibody activity in sera from syphilis patients, but not from those with autoimmunity. Lupus anti-coagulant activity correlated weakly with IgG antibody levels to each of the negatively charged phospholipids among the patients with autoimmunity. Lupus anticoagulant activity did not correlate uniquely with any anti-phospholipid antibody specificity. These results provide further documentation of the great heterogeneity of anti-phospholipid antibodies associated with autoimmune disease and syphilis.     

Infectious processes and systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune chronic inflammatory disease of unknown etiology, although genetic and environmental factors appear to contribute to its pathogenesis. Specifically, infectious processes are associated with SLE onset and exacerbation. However, we are far from a complete understanding of the interactions between infectious agents and the host, explaining the interest in gathering updated scientific information on this topic. According to the literature, the pathogens most frequently associated with SLE are viruses, notably human endogenous retroviruses, Epstein–Barr virus, parvovirus B19, cytomegalovirus and human immunodeficiency virus type 1, alongside certain bacterial components that can also trigger activation of the immune system. The mechanisms underlying autoreactivity remain unclear but various explanations have been proposed, including immunological changes responsible for infectious processes or molecular mimicry between host structures and those of infectious agents.     

系统性红斑狼疮合并胸腺瘤的临床特点分析

目的探讨系统性红斑狼疮(SLE)合并胸腺瘤的的临床特点。方法回顾性分析1984年至2015年北京协和医院收治的SLE合并胸腺瘤患者的临床资料,分析临床特点、实验室检查、治疗方式和预后,并与同期国内外报道的SLE合并胸腺瘤的病例资料进行比较。结果 SLE合并胸腺瘤住院患者共11例,占SLE患者的1.55‰,占胸腺瘤患者的1.07%。女性10例,男性1例。SLE平均起病年龄25.5岁,平均确诊年龄26.4岁,胸腺瘤的平均确诊年龄28.5岁。SLE进展至胸腺瘤的平均病程为2.1年。确诊胸腺瘤时SLEDAI均值为3.6。5例患者行胸腺切除术,1例患者放疗。4例胸腺瘤标本可用于WHO分型,A型2例,AB型1例,C型1例。8例患者随访3~92月,6例SLE稳定,1例SLE活动,1例死于肿瘤转移。与国内外文献报道资料相比,本研究中的SLE合并胸腺瘤患者年龄偏小,发现胸腺瘤后的手术切除率偏低。结论 SLE合并胸腺瘤并非偶然现象,胸腺瘤症状隐匿,可能参与SLE发病。胸腺切除可能有助于SLE的临床缓解,应引起临床医师的重视。