神经相关性自身抗体检测在神经精神性狼疮中的意义

目的 探讨神经相关性自身抗体在系统性红斑狼疮(SLE)和神经精神性狼疮(NPSLE)患者血清或脑脊液中的敏感性和特异性,评价其在NPSLE诊断中的意义.方法 利用间接免疫荧光法分别以成神经瘤细胞株(SK-N-SH)、神经胶质瘤细胞株(U251)以及C57BL/10小鼠的大脑及脊髓切片为底物检测121例SLE患者、34例疾病对照组和34名健康对照组的血清及24例NPSLE患者和22例疾病对照组的脑脊液中抗神经元细胞抗体、抗神经胶质细胞抗体、抗脑抗体及抗脊髓抗体.结果 SLE患者血清中抗神经元细胞抗体、抗脑抗体及抗脊髓抗体的阳性率(17.4%、25.6%和29.8%)明显高于类风湿关节炎(RA)患者以及正常对照组(P＜0.05或P＜0.01),在SLE诊断中的特异性分别为98.5%、95.6%和100%;抗神经元细胞抗体、抗脑抗体及抗脊髓抗体均与SLE疾病活动性指数(SLEDAI)积分呈正相关,并与NPSLE患者的癫痫发作、头痛、急性意识障碍以及情绪失调、焦虑等症状的发生有关;NPSLE患者血清的抗神经元细胞抗体、抗脑抗体和抗脊髓抗体的阳性率(27.8%、38.9%和61.1%)明显高于无中枢神经系统受累的SEE患者(P＜0.05或P＜0.01);NPSLE患者的脑脊液中抗脑抗体、抗脊髓抗体的阳性率均为29.2%,与疾病对照组比较,差异具有统计学意义(P＜0.05或P＜0.01);在NPSLE诊断中的特异性分别为100%和95.5%.结论 抗神经元细胞抗体、抗脑抗体及抗脊髓抗体对SLE诊断的特异性较高,但敏感性偏低;3种抗体均与SLE疾病活动性相关;血清中抗神经元细胞抗体、抗脑抗体及抗脊髓抗体是NPSLE诊断的较特异性抗体,抗脊髓抗体可能是诊断NPSLE较敏感的指标之一;脑脊液中的抗脑抗体、抗脊髓抗体对NPSLE的诊断更具有特异性.

The role of neuro-associated autoantibodies in neuropsychiatric systemic lupus erythematosus

Objective To evaluate the specificities and sensitivities of neuron-assoeiated(Neu-A) autoantibodies in the diagnosis of neuropsychiatric systemic lupus erythematosus(NPSLE)and explore its role in the pathogenesis of NPSLE.Methods The ncuro-associated autoantibodies including anti-neuroblastoma cell,anti-neuroglioma cell,and anti-brain,anti-spinal antibodies were tested using neuroblastoma cell line SK-N-SH.ueuroglioma cell line U251 or cerebrum and spinal meduHa of mice C57BL/10 as substrates respec tively,Serums of 121 SLE patients fincluding 36 NPSLE patients and 85 systemic lupus erythematosus (SLE)patients without CNS involvement),34 rheumatoid arthritis(RA)patients and 34 healthy controls were tested by indirect immunofluorescence(IIF)assay.Cerebrospinal fluid of 24 NPSLE patients and 22 CNS dis eases controls were also tested.Results The positive rates of anti-neuroblastoma cell antibodies,anti-brain and anti-spinal antibodies in serums of SLE patients were 17.4%,25.6%and 29.8%,respectively.Only 2.9%, 5.9%,0 in 34 RA patients and 0,2.9%,0 in health controls were positive(P＜0.05 or P＜0.01).The specificity of the three antibodies in SLE was 98.5%.95.6%and 100%respectively.Anti-neuroblastoma cell antibodies, anti-brain and anti-spinal antibodies were closely associated with SLEDAI score.The NPSLE patients with positive anti-neuroblastoma cell antibodies,anti-brain or anti-spinal antibodies had frequent seizure atlacks, headache,acute confusion state and mood disorders.There was a higher prevalence of anti-neuroblastoma cell.anti-brain and anti-spinal antibodies in NPSLE than those in SLE patients.29.2%anti-brain and anti- spinal antibodies were detected in the eerebrospinal fluid of NPSLE patients.which were significantly higher than those of disease control group(P＜0.05 or P＜0.01).The specificities of these two antibodies jn NPSLE were 100%and 95.5%respectively.Conclusion Anti-neumhlastoma cell antibody.anti-brain and anti spinal antibodies are valuable markers for the diagnosis of SLE.They are closely associated with the disease activity of SLE and neuropsychiatric symptoms.Anti-spinal antibody may be a sensitive and specific marker for the diagnosis of NPSLE while anti-brain and anti-spinal antibodies in the cerebrospinal fluid are more specifie for the diagnosis of NPSLE.