硬皮病相关自身抗体谱与中国系统性硬化患者临床相关性分析

目的分析硬皮病相关自身抗体谱[包括抗Scl-70抗体、抗RNA多聚酶Ⅲ抗体（ARA-Ⅲ）、抗着丝点抗体（ACA）和抗U1核糖核蛋白（U1RNP）抗体]与中国系统性硬化症（SSc）患者临床特征的相关性。方法前瞻性序贯纳入入选欧洲抗风湿病联盟硬皮病试验研究组（EULAR Scleroderma Trial and Research group,EUSTAR）的92例中国SSc患者,记录其临床表现和实验室检查结果,同时检测抗Scl-70抗体、ARA-Ⅲ、ACA和抗U1RNP抗体。统计分析上述自身抗体与患者各种临床特征之间的相关性。结果 92例患者中,弥漫型SSc65例,局限型SSc19例,重叠综合征6例,伴有雷诺现象的未分化结缔组织病2例。抗Scl-70抗体、ARA-Ⅲ、ACA和抗U1RNP抗体的阳性率分别为55%、13%、13%和25%。存在抗Scl-70抗体者具有较高的皮肤硬化修订Rodnan评分、免疫球蛋白（Ig）M及血小板水平,但肺动脉高压发生率、IgG水平则显著减低（P〈0.05）,与肺间质病变或肾危象的相关性未获证实。ARA-Ⅲ与皮肤硬化评分,毛细血管扩张,心、肺、肾脏受累等临床特点均无显著相关性。存在ACA的患者尿酸水平较高,但关节炎或关节痛症状和肺间质病变少见（P〈0.05）。存在抗U1RNP抗体者肺动脉高压和心脏受累的发生率、IgG和乳酸脱氢酶水平均增高,但白细胞和血小板较低（P〈0.05）。结论在SSc患者血清中检测上述硬皮病相关自身抗体有助于预测某些临床表现和脏器病变的发生。中国患者自身抗体的临床相关性可能与其他地区患者存在种族差异,值得进行更大样本的研究证实。     

抗增殖型细胞核抗原抗体在系统性红斑狼疮患者的临床意义

目的:探讨抗增殖型细胞核抗原(PCNA)抗体在系统性红斑狼疮(SLE)患者中的意义及临床相关性.方法:采用间接免疫荧光法(IIF)检测抗PCNA抗体,并用线性免疫印迹法将部分IIF-抗PCNA抗体阳性的患者血清进行特异性抗体检测.结果:抗PCNA抗体阳性患者55例,包括SLE 24例,占43%,未分化结缔组织病(UCT...     

间接免疫荧光试验检测抗核抗体的前带效应分析

目的探讨间接免疫荧光试验(IIFA)检测抗核抗体(ANA)中的前带效应对ANA荧光滴度的影响。方法将880例血清样本以1∶100稀释进行手工检测,筛选ANA荧光滴度≥1∶1 000的样本分别以1∶100、1∶1 000、1∶10 000稀释检测,统计有前带效应(1∶1 000稀释比1∶100稀释荧光亮)的样本数;将前带效应的样本采用欧蒙Sprinter XL全自动荧光加样仪和EUROPattern全自动荧光分析仪检测ANA(1∶100稀释),与手工法检测ANA(1∶100稀释)进行比较,检测前带效应样本的特异性自身抗体,分析其荧光模型、荧光滴度及阳性特异性自身抗体的分布特点。结果有明显前带效应的样本数为34例,占总样本数的3.86%,占高滴度(≥1∶1 000)ANA样本数的29.57%。通过手工法检测或通过Sprinter XL全自动荧光加样仪检测均发现前带效应,其荧光模型及荧光滴度相似,值得注意的是,EUROPattern只能选取图片中间区域判读。在有前带效应的血清样本中,以荧光滴度≥1∶10 000最常见(74.42%)。在荧光模型方面,以斑点型最为多见(46.51%)。在特异性自身抗体的分布方面,以抗核糖核蛋白(RNP)抗体最多见(62.79%),其次为抗双链DNA抗体(51.16%)和抗SSA抗体(51.16%)。结论 IIFA检测高滴度ANA样本在低稀释度时容易产生前带效应,从而导致错误的ANA荧光滴度判断,临床检验实验室应引起重视。     

神经精神性狼疮相关抗体及其诊断价值

神经精神性狼疮(neuropsychiatric systemic lupus erythematosus, NPSLE)是系统性红斑狼疮(systemic lupus erythematosus, SLE)病变累及神经系统而产生神经和/或精神症状的一组预后差、死亡率高的严重并发症, SLE患者血清或脑脊液中检测到的独特的自身抗体与神经精神疾病相关。在SLE患者中, NPSLE的患病率从17%至75%不等。本文论述国内外最新研究结果, 着重探讨抗核糖体P抗体、抗磷脂抗体、抗神经元抗体等相关抗体在中枢神经受累的NPSLE中的研究现状及其临床价值。     

血清中葡萄糖6-磷酸异构酶在类风湿关节炎中的诊断意义

目的 探讨血清中葡萄糖6-磷酸异构酶（glucose-6-phosphate isomerase,GPI）抗原升高在类风湿关节炎（rheumatoid arthritis,RA）患者诊断中的意义.方法 用酶联免疫吸附试验（ELIAA）检测128例RA患者,86例其他风湿病患者和42例健康对照血清中GPI抗原的浓度,RA患者同时还检测了类风湿因子（RF）,关节疼痛及肿胀数,血沉（ESR）,以及X线分级等.结果 128例RA患者血清中GPI浓度为（2.52±2.37）μg/ml,86例其他风湿性疾病组为（0.083±0.056）μg/ml,42例健康对照组为（0.081±0.050）μg/ml,RA患者血清中GPI浓度显著高于其他风湿病组和健康对照组（P＜0.05）,在RA活动组和RA非活动组,亦有显著差异（P＜0.05）.通过分段回归分析发现GPI的浓度和RA病情活动成正相关.GPI抗原对RA检测的敏感性为43.5%,特异性为98.3%.结论 GPI在部分RA患者血清中显著升高,有可能成为诊断RA及判断其疾病活动性的一个新指标.     

原发性胆汁性肝硬化患者CD11c+和CD123+树突状细胞与肝功能损伤的关系

目的:检测原发性胆汁性肝硬化(PBC)患者外周血树交状细胞亚群CD11c 和CD123 , 探讨其与肝功能损伤及抗线粒体抗体亚型 2(AMA-M2)抗体产生的关系．方法:流式细胞术检测PBC患者(n=40)外周血树突状细胞亚群CD11c 和CD123 比例, 以40例肝脏疾病患者作为疾病对照组,30例健康体检者作为正常对照组,观察CD11c 和 CD123 树突状细胞与患者的肝功能指标及 AMA-M2抗体产生的关系．结果:PBC患者外周血CD11c 和CD123 比例显著低于正常对照组(0．087 2±0．008 2 vs 0．169 0±0．011 3,P<0．01;0．034 9±0．004 9 vs 0．064 3±0．005 4,P<0．01)．肝功严重损伤的 PBC患者外周血CD11c 及CD123 比例显著低于轻度损伤者(0．071 6±0．007 3 vs 0．124 2 ±0．0094,P<0．01;0．042 6±0．005 9 vs 0．061 7 ±0．006 1,P<0．01)．AMA-M2 患者外周血 CD11c 和CD123 比例显著低于AMA-M2- 患者(0．076 1±0．005 1 vs 0．096 5±0．008 3, P<0．05;0．046 6±0．006 9 vs 0．063 1±0．005 7, P<0．05)．经动态观察发现,同一PBC患者经过治疗后CD11c 和CD123 比例增加,特别是 CD123 明显高于治疗前(0．058 3±0．004 9 vs 0．032 1±0．004 1,P<0．01)．结论:PBC患者外周血树突状细胞亚群 CD11c 和CD123 比例与肝功能损伤和血清抗AMA-M2抗体产生有密切关系．CD11c 和 CD123 的变化可能是导致肝功能损伤和病情发展及血清抗AMA-M2抗体产生的环节之一．     

去唾液酸糖蛋白受体H1亚单位基因片段的克隆表达及其检测自身免疫性肝炎的价值

Objective To clone and express the human asialoglycoprotein receptor(ASGPR) H1 subunit, purify and identify the immunoreactivity of the recombinant protein, and establish the enzyme linked immunosorbent assay (ELISA) to detect anti-ASGPR antibodies in diagnosis of autoimmune hepatitis. Methods The CRDHI cDNA (435 bp) was subcloned into eukaryotic vector PEGH, and the recombinant protein expression was induced by D (+)-Galactose. The recombinant CRDH1 was purified with Glutathione Sepharose 4B, and its immunoreactivity was identified by SDS-PAGE and western blot as well as MALDI-TOF. ELISA was established to detect the anti-ASGPR antibodies in serum samples of 45 patients with AIH, 30 patients with SLE, 30 patients with RA, 10 patients with SS and 30 normal controls. Results The sequencing of recombinant plasmid showed the CRDH1 gene was successfully inserted to the eukaryotic expression vector with correct sequence and open reading frame. The fusion protein showed a molecular weight of 42 500 Da on SDS-PAGE gel and confirmed to be the human ASGPR by MALDI-MS through peptide mass fingerprint analysis with Mascot in human protein database. It shared 98. 34% homology with ASGPR H1 subunit. Western blot analysis showed that the fusion protein had the same immunoreactivity as human ASGPR. The results of ELISA indicated that the positive rate of anti-ASGPR was 35.6% ( 16/45 ), but the ELISA was negative in other control. There was significant difference of positivity of the autoantibodies between AIH and non-AIH controls (χ2 = 31.85,P < 0. 01 ). Conclusions The human plasmid containing ASGPR is successfully clone into Saccharomyces cerevisiae Y258. The recombinant autoantigen owns good antigenicity and specificity. ELISA established with the purified protein shows good specificity for diagnosis of AIH.     

肠易激综合征脑-肠交互作用模型结肠组织蛋白指纹图谱初探

目的 建立肠易激综合征(IBS)动物模型,利用基质辅助激光解析电离飞行时间质谱(MALDI-TOF-MS)技术分析结肠组织差异蛋白质表达谱,为探索IBS发病机制提供线索.方法 雄性成年Wistar大鼠14只,随机分为模型组和正常组,每组7只.对模型组大鼠采用慢性轻度不可预见性应激联合急性束缚应激制作IBS慢急性联合应激大鼠模型,以行为学方法 评估模型.以MALDI-TOF-MS技术观察大鼠结肠蛋白质伞景,从整体上探索IBS这一功能性肠病有无差异表达蛋白.结果 (1)一般情况:模型组体重低于正常组[(298.88±18.61)g比(348.00±12.44)g,P<0.01];肠道动力:模型组大鼠制模后1 h的排便颗粒数明显多于正常组[(6.00±1.69)粒/1h比(1.14±0.69)粒1 h,P<0.01];行为检测:模型组与正常组相比,糖水消耗量显著减少[(13.63±1.69)ml/1 h比(19.00±3.06)ml/1 h,P<0.05];内脏敏感性:模型组在各个气囊容量下腹肌收缩次数均明显高于正常组(P<0.05).(2)MALDI-TOF-MS 鉴定结果 :模型组与正常组大鼠结肠组织有12个标志蛋白表达有明显差异,分为4类,分别与肠上皮细胞离子分泌、蛋白质合成、G蛋白系统、免疫有关;12种差异表达蛋白在模型组均高于正常组(P<0.05).结论 慢急性联合应激大鼠可部分模拟人类IBS脑-肠交互作用.差异蛋白质的检测为IBS发病机制及治疗靶点的选择提供了参考依据.     

电化学发光免疫测定与酶联免疫吸附试验检测抗环瓜氨酸多肽抗体比较

目的分析酶联免疫吸附试验(ELISA)和电化学发光免疫测定(ECLIA)检测抗环瓜氨酸多肽抗体(抗CCP抗体)的结果,并评价两种方法检测结果的一致性。方法应用ELISA和ECLIA同时检测145例类风湿关节炎(RA)患者(含25例早期RA患者)、155例其他风湿免疫性疾病患者(包括50例骨性关节炎、35例强直性脊柱炎、30例干燥综合征、20例系统性红斑狼疮、10例原发性胆汁性肝硬化和10例系统性硬化症)、50例其他疾病患者和50例健康对照者共400例血清样本的抗CCP抗体含量。用SPSS13.0统计软件对结果进行一致性、敏感性及特异性分析,并分别对3例ECLIA检测高浓度抗CCP抗体血清样本做1∶20、1∶30、1∶40、1∶80和1∶160稀释后进行线性分析。结果 ELISA和ECLIA检测400例血清样本抗CCP抗体的一致性极好;两种方法检测RA患者抗CCP抗体的敏感性和特异性近似,ECLIA分别为77.24%和98.00%,ELISA分别为76.55%和98.00%。3例ECLIA检测高浓度抗CCP抗体血清样本线性回归分析结果显示,样本浓度稀释至1∶160,线性R2值均>0.9。结论 ECLIA和ELISA检测抗CCP抗体具有较好的一致性,且ECLIA线性范围较宽,ECLIA检测抗CCP抗体具有良好的应用前景。     

抗膜突蛋白抗体与系统性硬化病相关肺间质病变的临床相关性研究

Objective To identify a novel auto-antibody in sera of systemic sclerosis (SSc) patients and to analyze its relevance with SSc-associated interstitial lung disease (ILD). Methods The anti-moesin antibody in the sera of 62 SSc patients, who had participated the European League Against Rheumatism's Scl eroderma Trial and Research Group (EUSTAR), were tested by enzyme linked immunosorbent assay (ELJSA). Patients were grouped by high resolution computerized tomography (HRCT) features, pulmonary function test (PFT) abnormalities, inflammatory markers and disease course. The prevalence and titer (Optical density value) of anti-moesin antibody were compared between groups with t and χ2 test. Results The titer of anti-moesin antibody was significantly higher in the SSc-ILD group than non-ILD group (0.156±0.062 vs 0.107± 0.026, P=0.005). Among SSc patients, the diagnostic sensitivity and specificity of the anti-moesin antibody for ILD was 44.0% and 91.7% respectively (Kappa=0.2, P=0.022). Anti-rnoesin antibody was more prevalent in SSc patients with HRCT features of honeycomb-like lesion, lobular septal thickening and mediastinal lymphadenopathy (P<0.05). SSc patients with deteriorated total lung volume (TLC %) had higher titer of anti-moesin antibody significantly (0.172±0.067 vs 0.133±0.039, P=0.011), as the same tendency in patients with decreased diffusing capacity of the lung for carbon monoxide (DLco% ) but without statistical significant difference (0.153±0.580 vs 0.120±0.340, P=0.089). The anti-moesin antibody was equally prevalent between abnormal ESR, C reactive protein, immunoglobulin and complements groups and their normal controls (P> 0.05). Group of patients who had SSc courses more than or less than 5 years demonstrated similar anti-moesin antibody titers (0.146±0.047 vs 0.164±0.077, P=0.272). However, patients with ILD courses less than 12 months had higher liter of the antibody than controls (0.182±0.073 vs 0.138±0.049, P=0.040). Conclusion This study suggests that the novel anti-moesin antibody has comparatively high specificity for SSc-associated ILD patients, which may contribute to further understanding the pathogenesis of ILD in SSc patients. Further investigations are deserved to evaluate the application of anti-moesin antibody in facilitating early screening and evaluation of ILD.