系统性红斑狼疮158例ANA荧光核型与ANA谱分析

目的 探讨抗核抗体（ANA）荧光核型与ANA谱对系统性红斑狼疮（SLE）患者的诊断价值.方法 对SLE组158例及非SLE组104例分别用间接免疫荧光法（IIF-ANA）和线性免疫印迹法（LIA-ANA）进行抗核抗体荧光核型、双链DNA及11项ANA谱分析.结果 SLE抗核抗体阳性率（〉1：100）为98.10%（155/158）,荧光核型以颗粒型、均质型为主,分别63.29%（100/158）、36.70%（58/158）,其次为浆颗粒型9.49%（15/158）,其中混合型占14.56%（23/158）.对ANA谱进行特异性与敏感性分析,抗Sm抗体是SLE特异性最强的一个指标（100%,104/104）,其次为组蛋白抗体（-Hi）、核糖体P蛋白抗体（-Rib）、核小体抗体（-Nud）及双链DNA抗体（-dsDNA）,特异性分别为99.04%（103/104）、99.04%（103/104）、98.08%（102/104）、98.08%（102/104）,P〈0.05.SLE组核均质型主要表现为-dsDNA、-Nud、-Hi、-SSA（P〈0.05）;核颗粒型主要表现为-dsDNA、-Nud、-nRNP/sm（P〈0.05）;核点型主要表现为着丝点B蛋白抗体（-CENP-B）（P〈0.05）;核仁浆颗粒混合型主要表现为Rib（P〈0.05）.结论 ANA谱靶抗原能精确到SLE疾病具体的靶抗体,特异性强;抗核抗体检测涵盖SLE现所已知与未知的种种靶抗体,敏感性强,两者联合检测、综合性分析可互为补充,有助于SLE的诊断与鉴别诊断,并可有效提高疾病诊断的特异性与敏感性.

The analysis of ANA fluorescence karyotype and ANA spectrum in 158 patients with systemic lupus erythematosus

Objective To investigate the diagnostic value of anti - nuclear antibody（ANA） fluorescence karyotype and ANA spectrum in the pantients with systemic lupus erythematosus （SLE）. Methods 158 cases of the patients with SLE and 100 cases of the control group were investigated in this study, serum level of ANA fluo- rescence karyotype and double stranded DNA（dsDNA） were measured by indirect itnmunofluorometric assay , and ANA spectrum（ 11 other polypeptides） were determined by linearity immunoblotting assay. Rusults Positive rate of patient with SLE was 98.10% （ 155/158）, In which 100（ 63.29% ） cases present granular pattern , 58（36.70% ） homogeneous pattern. Specificity and sensitivity analysis of ANA spectrum show that Sin was the most specific in- dex of SLE（ 100% ）, followed by histone（HI）, ribosome P, protein（ Rib）, nuclear body（Nud） and dsDNA with positive rate 99.00% （ 103/104） ,99.04% （103/104） ,98.08% （102/100） and 98.08（102/100） respectively; In this study, we demonstrate that dsDNA, Nud, HI, SSA were cardinal target antibodies of homogeneous pattern（ P 〈 0.05）. The main target antibodies of granular pattern were dsDNA, Nud, - nRNP/sm（ P 〈 0.05 ） ; CENP - B and Rib were the major target antibody of kinetoehore pattern and Rib pattern（ P 〈 0.05）. Conclusions Karyo- type multiplicity exists in serum of patient with SLE, the main fluorescence karyotype were granular pattern and homogeneous pattern. ANA fluorescence karyotype is closely related to ANA spectrum. As a result, detection of ANA karyotype and ANA spectrum can greatly improve the specificity of the diagnosis of SLE.