摘要
目的探讨血清抗C1q抗体与系统性红斑狼疮(SLE)活动性及狼疮性肾炎(LN)病理分型的关系,揭示抗C1q抗体在辅助诊断SLE、LN及评判其活动性中的临床价值。方法选取2012年12月—2013年8月在北京大学第一医院门诊就诊及住院的SLE患者120例〔SLE组,包括59例LN患者(LN组)和61例非LN患者(非LN组);61例活动期患者(活动组)和59例缓解期患者(缓解组)〕、其他自身免疫病患者100例(疾病对照组)及体检健康者120例(健康对照组)。采用ELISA法检测血清抗C1q抗体。比较各组抗C1q抗体情况,并与抗dsDNA抗体、补体及SLE疾病活动指数(SLEDAI)进行相关性分析。结果 SLE组血清抗C1q抗体阳性率〔35.8%(43/120)〕高于疾病对照组〔12.0%(12/100)〕和健康对照组〔5.0%(6/120)〕(P<0.017)。SLE活动组患者血清抗C1q抗体阳性率及水平高于缓解组〔49.2%(30/61)与22.0%(13/59),P<0.05;11.68(3.19,19.37)U/ml与3.76(1.93,8.28)U/ml,P<0.05〕;SLE轻、中、重度活动组患者抗C1q抗体阳性率及水平间均无差异(P>0.05)。LN组SLE患者血清抗C1q抗体阳性率高于非LN组〔50.8%(30/59)与21.3%(13/61),P<0.05〕。Ⅳ型LN患者血清抗C1q抗体阳性率高于Ⅱ+Ⅲ型〔68.8%(22/32)与23.5%(4/17),P<0.017〕。血清抗C1q抗体诊断LN的敏感度〔50.85%(37.64%,63.95%)〕低于抗dsDNA抗体〔69.49%(55.98%,80.46%)〕,但其特异度高于抗dsDNA抗体〔78.69%(65.98%,87.74%)与57.38%(44.10%,69.73%)〕。抗C1q抗体及抗dsDNA抗体联合检测诊断LN的特异度提高至88.52%(77.17%,94.88%)。血清抗C1q抗体与SLEDAI、抗dsDNA抗体水平呈正相关(r值分别为0.293和0.305,均P<0.01),与补体C3、C4呈负相关(r值分别为-0.290和-0.283,均P<0.01)。结论血清抗C1q抗体可作为一种简便、特异、无创的生物标记物,能客观反映SLE疾病活动性,有效指导LN病理分型,尤其是Ⅳ型LN。血清抗C1q抗体与抗dsDNA抗体联合检测可提高LN诊断的特异度。
Objective To explore the relationship between serum anti-Clq antibody and the activity of systemic lupus erythematosus（SLE） as well as the pathological type of LN,showing its clinical value in aided diagnosis of SLE and LN and judgment of its activity.Methods By ELISA,serum anti-C1q antibody were detected in 120 SLE patients 〔including 59 cases with LN（LN group） and 61 cases without LN（non-LN group）;61 active patients（active group） and 59 remission patients（remission group） 〕,100 patients with other autoimmune diseases（disease control group） and 120 healthy individuals（healthy control group） from Peking University First Hospital,December 2012 to August 2013.Anti-C1q antibody were compared in these different groups,and were analyzed with anti-dsDNA antibody,complement and SLEDAI.Results The positive rate of serum anti-C1q antibody in SLE group was significantly higher than that in disease control group and healthy control group 〔35.8%（43 /120） vs.12.0%（12 /100）,P〈0.017;35.8%（43 /120） vs.5.0%（6 /120）,P〈0.017〕.The positive rate and the level of serum anti-C1q antibody in the SLE active group were both significantly higher than those in the SLE remission group 〔49.2%（30 /61） vs.22.0%（13 /59）,P〈0.05;11.68（3.19,19.37） U /ml vs.3.76（1.93,8.28） U /ml,P〈0.05〕.The positive rate and the level of serum anti-C1 q antibody were both not significant in SLE different active groups（P〈0.05）.The positive rate of anti-C1 q antibody in LN was significantly higher than that in non LN group〔50.8%（30/59） vs.21.3%（13/61）,P 0.05〕.The positive rate of serum anti-C1 q antibody in Class Ⅳ LN patients was higher than that in Class Ⅱ＋Ⅲ LN patients 〔68.8%（22 /32） vs.23.5%（4 /17）,P〈0.017〕.The sensitivity of anti-C1 q antibody in the diagnosis of LN was lower than that of anti-dsDNA antibody 〔50.85%（37.64%,63.95%）vs.69.49%（55.98%,80.46%） 〕,but the specificity of anti-C1 q antibody in diagnosis of LN was higher than that of anti-dsDNA antibody 〔78.69%（65.98%,87.74%） vs.57.38%（44.10%,69.73%） 〕.If anti-C1 q antibody and anti-dsDNA antibody were combined detection,the specificity in diagnosis of LN could be increased to 88.52%（77.17%,94.88%）.The serum anti-C1 q antibody was positively correlated with the SLEDAI and the level of anti-dsDNA antibody（r= 0.293,P〈0.01;r=0.305,P〈0.01）,and negatively correlated with complement C3 and C4（r =-0.290,P 0.01;r =-0.283,P〈0.01）.Conclusion The serum anti-C1 q antibody,a simple,specific and non-invasive biomarker,can objectively reflect the disease activity of SLE and effectively guide the clinical judgment of the LN pathological types,particularly diffuse proliferative LN（class Ⅳ）.The serum anti-C1 q antibody and anti-dsDNA antibody combined can improve LN diagnostic specificity.
出处
《中国全科医学》
CAS
CSCD
北大核心
2014年第17期1989-1993,共5页
Chinese General Practice
