抗β2糖蛋白I抗体在系统性红斑狼疮合并自身免疫性溶血性贫血中的意义

目的检测抗β2糖蛋白I抗体(β2 glycoprotein I,aβ2GPI)等多种自身抗体在系统性红斑狼疮(systemic lupus erythematous,SLE)并发自身免疫性溶血性贫血(autoimmune hemolytic anemia,AIHA)患者的阳性率,评估aβ2GPI在并发AIHA的SLE患者中的意义。方法收集2008年12月至2013年4月福建医科大学附属第一医院风湿科门诊和病房SLE患者资料,根据有无发生AIHA分为SLE-AIHA组和SLE-non-AIHA组。选取AIHA患者为AIHA组。检测IgM和IgG类的aβ2GPI、抗心磷脂抗体(anticardiolipin,ACL),以及抗Sm抗体、核小体抗体、组蛋白抗体、核糖体P蛋白抗体等多种自身抗体,采用SPSS11.5软件统计分析。结果共纳入SLE患者104例,SLE-AIHA组22例,SLE-non-AIHA组82例;AIHA组20例。SLE-AIHA组和SLE-non-AIHA组在年龄、性别、病程、受累器官等方面均无统计学差异;而SLE-AIHA组的IgG类aβ2GPI阳性率达45.5%,显著高于SLE-non-AIHA组的15.9%,差异有统计学意义(P0.01);两组患者的IgM类aβ2GPI、IgM和IgG类ACL、抗Sm抗体、核小体抗体、组蛋白抗体、核糖体P蛋白抗体阳性率比较差异均无统计学意义(均P0.05);SLE-AIHA组和AIHA组患者aβ2GPI和ACL阳性率比较差异均无统计学意义(均P0.05);SLE-AIHA组IgG类aβ2GPI阳性患者肾损害发生率高于该抗体阴性者,差异有统计学意义(P0.05)。结论 IgG类aβ2GPI在并发AIHA SLE患者和原发性AIHA患者中均表现较高阳性率,可能是SLE并发AIHA的重要血清学特征;同时该抗体可能是继溶血事件后加重狼疮患者肾损害的重要因素之一。

Role of Anti-beta 2 Glycoprotein I Antibodies in Systemic Lupus Erythematosus Patients with Autoimmune Hemolytic Anemia

Objective To assess the positive rate of anti-beta2 glycoprotein I antibodies （aβ2GPI） and other autoantibodies in patients with systemic lupus erythematosus （SLE） concurrent with autoimmune hemolytic anemia （AIHA）, and evaluate the clinic significance of aβ2GPI in these patients. Methods From December 2008 to April 2013, consecutive patients with SLE were studied in the First Affiliated Hospital of Fujian Medical University. According to whether concurrent with AIHA or not, SLE patients were divided into the SLE-AIHA Group and SLE-non-AIHA Group, while patients with primary autoimmune hemolyticanemia were selected in the AIHA Group. Levels of anti-β2GPI antibody, anticardiolipin antibody, anti-SM antibody, antinuclear antibody, anti-histone antibody, antiribosomal-P protein antibody and other autoantibodies were assessed in all cases. Data were analyzed by SPSS 11.5. Results 104 patients with SLE were included in the study, 22 patients with clinical manifestation of autoimmune hemolytic anemia （ AIHA）, and 82 patients without AIHA ; while 20 patients with primary autoimmune hemolytic anemia were selected as the control group. There was no significant difference in age, sex, disease duration and levels of IgM subtype anti-β2GPI antibody, anticardiolipin antibody, anti-SM antibody, antinuclear antibody, anti- histone antibody, antiribosomal-P protein antibody between patients with SLE who had AIHA and those who did not. But the titers of IgG subtype anti-beta2 glycoprotein I antibodies in patients with AIHA were 45.5%, which was higher than those patients without AIHA （P 〈0. 05 ）. The positive rate of aβ2GPI and ACL were similar in patients of the SLE-AIHA Group （ P 〉 0.05 ）. Autoimmune hemolytic anemia at the onset of SLE, who were positive for IgG aβ2GPI, was independently associated with renal involvement （P 〈 0.05）. Conclusion The higher prevalence of IgG aβ2GPI in patients with AIHA suggests that the occurrence of autoimmune hemolytic anemia may define a subgroup of patients with SLE who have characteristic serological profiles. Anti-β2GPI antibody may be one of the major factors involves in the aggravation of renal function of patients with SLE.