SLE新的抗SmD1抗体检测的临床意义

目的：探讨新的抗SmD1抗体检测在系统性红斑狼疮（SLE）诊断中的价值。方法：用放射免疫分析检测SLE患者血清中的抗dsDNA抗体,ELISA定量法检测抗SmD1抗体、抗Sm抗体,同时用其它风湿病患者及正常健康人血清作对照。结果：80例SLE患者抗SmD1抗体阳性率为52.5,抗Sm抗体阳性率12.5,抗dsDNA抗体阳性率33.8,80例对照组抗SmD1抗体、抗Sm抗体阳性率分别为4.0、0。结论：新的抗SmD1抗体在SLE中敏感性和特异性均较高,抗SmD1抗体可作为诊断SLE的参考指标。     

自身抗体联合检测对系统性红斑狼疮诊断的意义

为了评价抗核小体抗体(anti-nucleosome antibody,AnuA)、抗Sm抗体、抗双链DNA(double stranded-DNA,dsDNA)抗体、抗核糖体P蛋白(ribosomal P protein,rRNP)抗体联合检测对系统性红斑狼疮(SLE)诊断的价值,采用酶联免疫吸附法(ELISA)测定123例SLE患者、61例其他结缔组织病患者和30名健康对照者血清中An.uA、抗dsDNA抗体、抗Sm抗体、抗rRNP抗体含量.结果显示,AnuA、抗dsDNA抗体、抗Sm抗体和抗rRNP抗体在SLE患者中的阳性率明显高于疾病对照组和正常对照组;AnuA与抗dsDNA抗体的敏感性显著高于其他两种自身抗体;抗dsDNA抗体、抗sm抗体和抗rRNP抗体阴性的SLE患者中,AnuA阳性率为52.6%～68.0%;SLE活动期患者与非活动期患者AnuA、抗dsDNA抗体阳性率有显著性差别.四种自身抗体在SLE的诊断中有明显的互补作用,特别是AnuA和抗dsDNA抗体可以弥补其他抗体的不足;AnuA、抗dsDNA抗体与疾病活动性密切相关.AnuA与抗sm抗体或AnuA与抗dsDNA抗体的二联检测可明显提高其对SLE诊断的敏感性.AnuA、抗dsDNA抗体、抗Sm抗体三联检测的阳性率可达87%.自身抗体联合检测提高了诊断的敏感性,对SLE的诊断和治疗有重要意义.     

自身抗体检测在儿童系统性红斑狼疮诊断中的意义

目的 探讨抗核抗体（ANA）、抗双链DNA（ds-DNA）、抗ENA抗体检测在儿童系统性红斑狼疮（SLE）诊断中的价值。方法 利用酶免疫斑点技术对56例SLE患儿的抗核抗体、抗ds-DNA、抗ENA抗体进行检测。结果 56例SLE患儿ANA阳性率最高94．6％，抗ds-DNA阳性率为55．4％，抗Sm／RNP阳性率64.8％，抗SSMSSB阳性率60.7％。结论 SLE患者血清中存在多种自身抗体，自身抗体的联合检测对SLE的诊断和病情的监测有着重要的意义。     

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.     

系统性红斑狼疮患者血清抗dsDNA抗体的表达水平变化及临床意义分析

目的：通过检测系统性红斑狼疮（SLE）患者血清中抗dsDNA抗体,探讨抗dsDNA抗体在SLE的诊断与治疗中的临床意义。方法：用间接结合的放射性核素检测法（radioisotopic methods）检测SLE患者及疾病对照组（原发性干燥综合征,系统性硬化征,类风湿关节炎,多发性肌炎,混合性结缔组织病,强直性脊柱炎等）血清中的抗dsDNA抗体,同时评估SLE患者的各种临床表现（SLEADI）及实验室指标,并分析其与抗dsDNA抗体的相关性。结果：①60例SLE患者中有39例抗dsDNA抗体为阳性,阳性率为65%,抗dsDNA抗体,在33例对照组中有2例为阳性,阳性率为6.7%,抗dsDNA抗体在SLE的敏感性为65%,特异性为93.3%;②抗dsD-NA抗体与Sm抗体无相关性（P〉0.05）;与抗SSA抗体有相关性（P〈0.05）;③抗dsDNA抗体阳性患者的脱发,皮疹,口腔溃疡,蛋白尿等临床表现的发生率明显高于阴性患者（P〈0.05）;④抗dsDNA抗体阳性患者的白细胞、血小板降低等的发生率明显高于阴性患者,差异有绝对统计学意义（P〈0.05）。结论：抗dsDNA抗体作为SLE的特异性标记的抗体,其表达与疾病的活动性及严重程度密切相关。     

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。     

抗C1q抗体与系统性红斑狼疮患者病情活动的相关性及其临床意义

目的探讨抗C1q抗体（C1qAb）与系统性红斑狼疮（SLE）患者病情活动的相关性及其临床意义。方法用酶联免疫吸附实验（ELISA）检测98例SLE患者、108例其他风湿病患者及67例健康体检者中血清抗C1qAb,并对SLE患者的其他实验室检测结果进行统计学分析。结果SLE患者血清中抗C1qAb阳性率显著高于其他风湿病及健康体检者（P〈0．05）;其中,抗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抗C1qAb阴性患者（P〈0．05）。结论血清抗C1qAb与SLE肾脏损害密切相关,其还可作为判断SLE病情活动的指标。     

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。     

系统性红斑狼疮患者自身抗体联合检测的诊断意义

目的:通过检测抗Sm抗体、抗dsDNA抗体、抗核糖体P蛋白抗体(anti-rRNP),探讨它们在系统性红斑狼疮(SLE)中的临床意义。方法:采用免疫荧光法对93例SLE患者及120例其他自身免疫病患者(简称非SLE组)进行抗Sm抗体、抗dsDNA抗体、抗核糖体P蛋白抗体检测;数据采用统计软件SPSS13.0进行分析,组间率比较用R×C表χ2检验。结果:三种抗体阳性率无论是单项检测还是联合检测都明显高于非SLE组(P<0.01),任一种抗体阴性的SLE患者血清中,多数可以检测到一种或几种抗体,三种抗体联合检测与单项检测相比,灵敏性与阴性预测值有所降低,特异性与阳性预测值(除anti-dsDNA+anti-rRNP外)有所提高。结论:三种自身抗体在SLE的诊断中的意义不尽相同,联合检测将更有利于SLE的诊断及鉴别诊断。     

13种自身抗体检测对SLE的诊断价值及临床意义

目的探讨13种自身抗体对系统性红斑狼疮（SLE）的诊断价值和临床意义。方法抗核抗体（ANA）的检测采用间接免疫荧光法;抗ds-DNA抗体的检测采用快速金标渗滤法;11种可抽提核抗原（ENA）抗体的检测采用免疫印迹法。结果（1）223例SLE患者抗核抗体谱中,ANA、ds-DNA及抗ENA抗体SS-A/Ro60、SmD1、SS-A/Ro52和U1-RNP的阳性率较高,分别为95.06%、52.91%、50.22%、27.35%、24.66%和21.08%;Jo-1和P0抗ENA抗体的阳性率较低,分别为1.79%和0.90%;正常对照组仅ANA有5%的阳性率,其余抗体均为阴性。（2）抗体阳性的患者主要集中在10～50岁之间,10岁以下和50岁以上的患者比较少,平均年龄35岁。（3）SLE患者ANA-LIA的检测大多数患者的条带在4条以内,随着条带的增多,患者的数量减少。（4）抗ds-DNA抗体与抗SmD1抗体、抗核小体抗体的阳性率有显著差异（P〈0.01）,与抗SS-A/Ro60抗体的阳性率比较无显著差异（P〉0.05）。抗SmD1抗体与抗核小体、抗SS-A/Ro60抗体的阳性率有显著差异（分别为P〈0.05和P〈0.01）,与抗U1-RNP抗体的阳性率无显著差异（P〉0.05）。（5）104例SLE患者的血清免疫球蛋白和补体水平的异常,主要体现在IgG和C3异常。结论自身抗体的检测对SLE的诊断、治疗和疗效观察具有重要意义,多项自身抗体联合检测有利于提高SLE的免疫学诊断的阳性率。     

Sera from patients with rheumatic diseases recognize different epitope regions on the 52-kD Ro/SS-A protein.

Patients suffering from systemic lupus erythematosus (SLE) or Sjögren's syndrome (SS) often contain autoantibodies directed to the Ro(SS-A) complex. In this study the antigenic determinants on two of the components of the Ro complex, i.e. the Ro60 and the Ro52 polypeptides, were investigated. Anti-Ro+ sera were selected by counter-immunoelectrophoresis. Depending on the detection method, 59-68% of the SLE patients produced anti-Ro but not anti-La antibody, while 72-81% of the SS patients produced both anti-Ro and anti-La antibody. Immunoprecipitation of recombinant Ro-proteins showed that 61 sera (87%) were reactive with both Ro proteins, seven sera with Ro60 only, one serum with Ro52 only, and one serum did not precipitate the proteins at all. The anti-Ro60 reactivity of human sera is strongly associated with the native form of Ro60, suggesting that conformational autoepitopes are an important feature of Ro60. In the case of Ro52, frequently the residues located between amino acids 216 and 292 were essential for reactivity with the antibodies. With 70% of the lupus sera tested this appeared to be the only region important for reactivity. The antibodies of SS patients generally recognized multiple B cell epitopes located between amino acids 55 and 292. The results of this study indicate that the antigenic determinants on Ro52 are different for autoantibodies produced by lupus patients compared with those of SS patients.     

Comparison of the anti-Ro/SSA autoantibody profile between patients with primary and secondary Sjögren's syndrome

OBJECTIVE: To measure serum levels of anti-Ro52-kD/SSA, anti-Ro60-kD/SSA and anti-La/SSB autoantibodies in patients with primary and secondary Sj?gren's syndrome. To examine if there is any connection between the disease and the subtype-spectrum of these antibodies. METHODS: We measured serum levels of anti-Ro52-kD/SSA, anti-Ro60-kD/SSA and anti-La/SSB autoantibodies by ELISA, in the sera of patients with primary Sj?gren's syndrome with or without extraglandular manifestations and with or without anti-La/SSB positivity and of patients with systemic lupus erythematosus/Sj?gren's syndrome overlapping disease with or without anti-La/SSB positivity. RESULTS: Differences of the distribution of the anti-Ro52-kD/SSA and the anti-Ro60-kD/SSA were found between the primary and secondary Sj?gren's syndrome patients' groups; when Sj?gren's syndrome is accompanied by systemic lupus erythematosus, the occurrence of anti-Ro60-kD/SSA autoantibodies is significantly higher than in primary Sj?gren'syndrome. CONCLUSION: Our results suggest that there is a possible connection between the distribution of the subtypes of the anti-Ro/SSA autoantibodies and the disease type in primary/secondary Sj?gren's syndrome.     

An updated review of anti-Ro52 (TRIM21) antibodies impact in connective tissue diseases clinical management

Anti-Ro52 (or anti-TRIM21) antibodies are part of the family of anti-Ro/SSA antibodies, historically markers of Sjögren syndrome and systemic lupus erythematosus. Anti-Ro52 antibodies represent one the most frequently encountered autoantibodies in patients with connective tissue disease (primary Sjögren syndrome, systemic lupus erythematosus, systemic sclerosis and idiopathic inflammatory myopathies). Because of their lack of specificity and detection in patients with non-autoimmune disorders, the usefulness of anti-Ro52 testing in connective tissue diseases is still matter of debate among clinicians and immunologists. Autoantibodies are mainly diagnostic markers for autoimmune diseases but some of them can also be directly involved in the generation of tissue damage. Over the past decade several authors reported associations of anti-Ro52 antibodies with some clinical features – especially interstitial lung disease – and survival in patients with connective tissue diseases. There is also a growing evidence of the role of anti-Ro52 antibodies in the pathogenesis of connective tissue diseases. In this review, we comprehensively discuss the clinical associations of anti-Ro52 antibodies in the different connective tissue diseases and the recent advances on their potential role in the inflammatory response.     

自身抗体联合检测对系统性红斑狼疮的诊断价值

研究抗核抗体(ANA)、抗双链DNA(ds-DNA)抗体、抗Smith(Sm)抗体、抗核小体抗体(AnuA)和抗核糖体P蛋白抗体(ARPA)5种自身抗体单项及联合检测系统性红斑狼疮(SLE)诊断中的价值.测定了66例SLE患者和50例其他疾病患者(对照组)血清中的自身抗体.以间接免疫荧光法测定ANA;免疫印迹法测定抗ds-DNA抗体、抗Sm抗体、AnuA和ARPA.结果显示,在66例SLE患者中ANA、抗ds-DNA抗体、抗Sm抗体、AnuA和ARPA的阳性率分别为92.4%、27.2%、42.4%、71.2%和16.6%,均明显高于对照组(32%、2%、2%、4%和2%)(P＜0.01);ANA、AnuA的敏感性明显高于其他3种抗体(P＜0.01);ANA、抗ds-DNA抗体、抗Sm抗体、AnuA和ARPA的特异性分别为68.0%、98.0%、98.0%、96.0%和98.0%.结论:抗ds-DNA抗体、抗Sm抗体、AnuA和ARPA等4种自身抗体对SLE的检测有很高的特异性,且有明显的互补作用,联合检测能提高对SLE检测的敏感性.     

New coupled-particle light-scattering assay for detection of Ro/SSA (52 and 60 kilodaltons) and La/SSB autoantibodies in connective tissue diseases

The diagnostic and analytical performance of the coupled-particle light-scattering assay in detecting anti-Ro/SSA autoantibodies (the 60-kDa [Ro60] and the 52-kDa [Ro52] antibodies) and anti-La/SSB autoantibodies was evaluated. The antigens were obtained by recombinant DNA procedures to include the most immunogenic epitopes for each protein by using a prokaryotic expression system. Serum samples from 151 patients with connective tissue diseases and 52 control subjects (including patients with viral infections, patients with Lyme disease, and healthy subjects) were studied. Sensitivities for detection of anti-Ro/SSA and anti-La/SSB were 88.2 and 95.2%, respectively; specificities were 97.6 and 98.1%, respectively. The intra-assay coefficient of variation (CV) ranged from 4.3 to 10.9% for anti-Ro/SSA and from 2.8 to 12.5% for anti-La/SSB; interassay CVs ranged from 6.5 to 13.2% and from 8.2 to 14.5%, respectively. Among the anti-Ro/SSA-positive samples, Ro60 was recognized by 66% of the test sera and Ro52 was recognized by 95% of the test sera. Thirty-four percent of the Ro/SSA-positive sera were reactive only with the Ro52 antigen, indicating that anti-Ro52 is the most common antibody specificity recognized by anti-Ro/SSA autoantibodies. No differences were found between the prevalences of anti-Ro60 and anti-Ro52 in relation to systemic lupus erythematosus or Sj?gren's syndrome. The results of the present study indicate that this new immunoassay is an efficient diagnostic tool for the detection of anti-Ro/SSA and anti-La/SSB antibodies in patients with autoimmune disorders.     

ANA negative (Ro) lupus erythematosus with multiple major organ involvement: a case report

Anti-nuclear antibody (ANA) negative systemic lupus erythematosus (SLE) occurs in about 4-13% of SLE cases. A small group of ANA negative SLE patients with positive anti-Ro antibodies usually present with typical vasculitic skin lesions which can be associated with photosensitivity, renal disease, congenital heart block or neonatal lupus. We present a case of a persistently ANA negative patient who presented with joint pain, rashes, mouth ulcer and alopecia. Clinical diagnosis of systemic lupus erythematosus was made even though ANA was negative. She was started on steroids and went into remission. Later, she developed several episodes of convulsions associated with fever and prominent vasculitic lesions. The patient was also found to have microscopic hematuria, proteinuria, anemia and thrombocytopenia. Renal biopsy showed lupus nephritis class 1B. Due to the prominent skin lesions, we performed anti-extractable nuclear antigens (ENA) antibodies test and anti-Ro turned out to be positive. The final diagnosis was ANA negative SLE (Ro lupus) with cutaneous, renal, musculoskeletal, hematological and cerebral Involvement.     

New Coupled-Particle Light-Scattering Assay for Detection of Ro/SSA (52 and 60 Kilodaltons) and La/SSB Autoantibodies in Connective Tissue Diseases

The diagnostic and analytical performance of the coupled-particle light-scattering assay in detecting anti-Ro/SSA autoantibodies (the 60-kDa [Ro60] and the 52-kDa [Ro52] antibodies) and anti-La/SSB autoantibodies was evaluated. The antigens were obtained by recombinant DNA procedures to include the most immunogenic epitopes for each protein by using a prokaryotic expression system. Serum samples from 151 patients with connective tissue diseases and 52 control subjects (including patients with viral infections, patients with Lyme disease, and healthy subjects) were studied. Sensitivities for detection of anti-Ro/SSA and anti-La/SSB were 88.2 and 95.2%, respectively; specificities were 97.6 and 98.1%, respectively. The intra-assay coefficient of variation (CV) ranged from 4.3 to 10.9% for anti-Ro/SSA and from 2.8 to 12.5% for anti-La/SSB; interassay CVs ranged from 6.5 to 13.2% and from 8.2 to 14.5%, respectively. Among the anti-Ro/SSA-positive samples, Ro60 was recognized by 66% of the test sera and Ro52 was recognized by 95% of the test sera. Thirty-four percent of the Ro/SSA-positive sera were reactive only with the Ro52 antigen, indicating that anti-Ro52 is the most common antibody specificity recognized by anti-Ro/SSA autoantibodies. No differences were found between the prevalences of anti-Ro60 and anti-Ro52 in relation to systemic lupus erythematosus or Sjögren's syndrome. The results of the present study indicate that this new immunoassay is an efficient diagnostic tool for the detection of anti-Ro/SSA and anti-La/SSB antibodies in patients with autoimmune disorders.     

Detection of anti-Ro(SSA) antibodies by gel double diffusion and a 'sandwich' ELISA in systemic and subacute cutaneous lupus erythematosus and Sj?gren's syndrome

A newly described Ro 'sandwich' ELISA was compared to the gel double diffusion technique to detect anti-Ro(SSA) antibodies in Sj?gren's syndrome, systemic and subacute cutaneous lupus erythematosus patients. This study demonstrates that the ELISA assay increased the frequency of detection of anti-Ro(SSA) antibodies in these well defined connective tissue disease patients by approximately 5-10% compared to the gel double diffusion anti-Ro(SSA) antibody assay. The study also confirms that some patients make anti-Ro(SSA) antibodies directed solely at unique human Ro(SSA) antigen epitopes. We also detected the existence of a significant Sj?gren's syndrome patient population failing to make significant anti-Ro(SSA) antibodies. We conclude from our study that the gel double-diffusion technique employing human spleen extract as a source of the Ro(SSA) antigen is, at present, the most cost-effective test to detect anti-Ro(SSA) antibodies.     

Detection and occurrence of the 60- and 52-kD Ro (SS-A) antigens and of autoantibodies against these proteins.

The simultaneous detection of anti-La, anti-60-kD Ro and anti-52-kD Ro antibodies by immunoblotting is greatly improved by changing the crosslinking level in the gel to an acrylamide/bisacrylamide ratio of 19:1. Using this method for the analysis of a number of systemic lupus erythematosus (SLE) and Sjögren''s syndrome patient sera it was observed that antibody to the 52-kD Ro protein without anti-60-kD Ro antibody was restricted to Sjögren''s syndrome patients (9/26), whereas antibody to the 60-kD Ro protein without contaminating anti-52-kD Ro antibody was only found in SLE patients (8/38). Moreover, in Sjögren''s syndrome patient sera anti-Ro antibody was found only in combination with anti-La antibody (20/26), whereas in SLE patient sera anti-Ro antibody could be found without detectable anti-La specificity (4/38). Double immunofluorescence microscopy revealed that the 52-kD Ro and the 60-kD Ro proteins co-localize in the cytoplasm as well as in the nucleus, whereas immunoprecipitation of [32P]-labelled HeLa cell extract with monospecific anti-52-kD Ro and anti-60-kD Ro sera showed that both proteins are associated with the Ro RNAs. These data suggest the presence of both the 52-kD and the 60-kD Ro proteins in the same ribonucleoprotein complexes. To study the evolutionary conservation of the 52-kD Ro, the 60-kD Ro and the La proteins, extracts of cell lines derived from various mammalian species were analysed on Western blots using monospecific human antibodies. In contrast to the 60-kD Ro and the La antigens which are well conserved in evolution, the 52-kD Ro antigen could be detected in primate cells only by this immunological approach.