IgG型抗dsDNA抗体及其亚型与狼疮肾炎临床和病理关系探讨

目的比较狼疮肾炎（LN）患者和非LN的系统性红斑狼疮（SLE）患者血清IgG抗dsD-NA抗体及其亚型的分布,探讨抗dsDNA抗体与LN病理间的关系,为LN的早期诊断和制定治疗方案提供依据。方法以健康个体为正常对照组,病例组选自两所三甲医院住院的SLE患者,病例组又分为LN和非LN两组,采用双抗夹心酶联免疫吸附试验测定研究对象外周血IgG型抗ds-DNA抗体及其亚型,SPSS 10.0进行统计分析。结果SLE患者与正常对照相比,血清IgG型抗dsDNA抗体阳性率差异有显著性（χ2=31.16,P〈0.001）,但是SLE非LN患者与LN患者相比,血清IgG型抗dsDNA抗体阳性率差异无显著性（χ2=0.021,P=0.885）。血清IgG1（χ2=5.35,P=0.021）和IgG2（χ2=5.24,P=0.022）在非LN的SLE患者与LN患者两组中的分布差异具有显著性,而血清IgG3差异无统计学意义（χ2=0.09,P=0.755）,两组间均未检测到血清IgG4亚型。血清总IgG抗dsDNA抗体与狼疮肾炎活动性指标和慢性指标有关,在其亚型中,仅见IgG2亚型与狼疮肾炎活动性指标有关,而未见各亚型与慢性指标有关。结论IgG1和IgG2升高可能参与了LN的发病,且IgG2与其活动性呈正相关,可反映疾病的严重程度,在临床诊断上具有一定的价值。血清抗dsDNA抗体与LN临床活动性指数相关,可以作为LN活动的指标。

The relationship between IgG anti-dsDNA antibody and its subclass with lupus nephritis

Objective To analyse the relationship between serum IgG anti-dsDNA antibody with lu- pus nephritis, and to analyse the relationship between four serum IgG anti-dsDNA antibody subclasses with disease activity. Methods SLE patients Were selected from two hospital,and then divided into two groups that were LN group and SLE not LN group, and normal healthy volunteers were recruited as controls. General information and the data of renal damage were collected by self-designed questionnaire containing SLEDAI, AI, CI. ELISA was used to detect the levels of IgG anti-dsDNA antibody and its subsets. Results Patients with SLE （ n = 60） had a significantly higher positive rate of IgG anti-dsD- NA antibody compared to healthy controls （ n = 60） （χ2 = 31. 16, P 〈 0. 001 ）, but that was no signifi- cant difference between LN group （ n = 28） and SLE not LN group （ n = 32 ） （χ2 = 0.021, P = 0. 885）. There was a rdationship between serum IgG anti-dsDNA antibody and active index and chronic index, but further reseach suggested only IgG2 anti-dsDNA antibody had been related to active index. Conelu- sions IgG1 and IgG2 subclass antibodies to dsDNA were the predominant subclasses found in serum of patients with LN,the frequent occurrence of a rise in IgG2 anti-dsDNA antibody in active LN patients suggests that IgG2 subclass antibodies have a particular pathophysiological role in lupus nephritis.