间接免疫荧光法检测神经精神狼疮患者神经反应性自身抗体的临床意义

目的 探讨神经精神狼疮（NPSLE）患者血清/脑脊液（CSF）中特异/非特异的神经反应性自身抗体,在NPSLE发病中的作用.方法 收集NPSLE组25例患者和系统性红斑狼疮（SLE）伴中枢神经系统（CNS）感染对照组11例患者的血清和脑脊液,另收集SLE不伴神经精神累及（non-NPSLE）对照组10例患者血清,分别以人喉癌上皮细胞（Hep-2）和猴小脑组织和外周神经薄片为抗原基质检测自身抗体荧光模型.结果N PSLE组和两组SLE对照组血清抗核抗体（ANA）阳性率差异无统计学意义（P＞0.05）,NPSLE组CSF的ANA阳性率为60%（15/25）,SLE感染对照组为27%（3/11）（P＜0.01）;PSLE组血清神经组织反应性抗体的阳性率显著高于SLE感染对照组和non-NPSLE对照组比较差异有统计学意义（P＜0.001）.结论 （1）SLE患者CSF ANA阳性率与SLE活动和神经系统累及有关,尤其重症病例可见较高滴度;（2）血清中神经组织反应性自身抗体阳性与NPSLE发病有关,其产生和发病机制有待探究.

Clinical significance of neuro-reactive autoantibodies in neuro-psychiatric systemic lupus erythematosus

Objective To investigate the clinical significance of specific/non-specific neuro- reactive autoantibodies in the pathogenesis of neuropsychiatric systemic lupus erythematosus(NPSLE). Methods Samples of serum and cerebrospinal fluid(CSF)were collected from 25 NPSLE patients,11 patients with SLE complicated with central nervous system(CNS)infection(control group 1),and 10 SEE patients without CNS infection(non-NPSLE,control group 2))were detected,Indirect immunofluorescence technique was used to detect the anti-nuclear antibody(ANA)based on the slides with human epithelium cell of laryngocarcinoma of the line Hep-2 or on the slides with cerebellum and peripheral nerve of monkey, he type of immunofluorescence were assayed.Results The percentages of ANA positive serum of the NPSLE,SLE control 1,and SLE control 2 groups were 92%(23/25),100%(11/11),and 100%(10/ 10)respectively without significant differences between any 2 groups(all P>0.05).The percentage of ANA positive CSF of the NPSLE was 60%(15/25),significantly higher than that of the SLE control group 1(27%,3/11,P<0.01).There was no significant correlation between the titer of serum ANA and the titer of CSF ANA(P>0.05).The positive rate of neuro-reactive autoantibodies was 40%(10/25), significantly higher than those of the 2 control groups(both 0,both P>0.001).Conclusion (1)The ANA positivity in the CSF of the NPSLE group is associated with the disease activity and CNS involvement, the higher the titer of autoantibodies the severe the clinical manifestations.(2)The nenro-reactive autoantibodies in the serum may associate with NPSLE with still unknown mechanism.