高亲合力抗双链DNA抗体对系统性红斑狼疮的诊断价值

欧阳芬; 张乔轩; 李妙言; 柯培锋; 何敏

doi:10.13898/j.cnki.issn.1000-2200.2021.06.024

高亲合力抗双链DNA抗体对系统性红斑狼疮的诊断价值

Diagnostic value of high affinity anti-double-stranded DNA antibody in systemic lupus erythematosus

摘要

摘要:
目的探讨高亲合力抗双链DNA抗体（抗dsDNA抗体）在系统性红斑狼疮（SLE）病人中的分布情况以及与性别、年龄、狼疮肾炎等指标之间的关系。
方法收集2017年8月至2018年4月广东省中医院抗dsDNA抗体阳性的血清标本共155例，其中SLE组116例，非SLE组39例，分别使用酶联免疫吸附试验（ELISA）和间接免疫荧光法（IIF）同时测定血清样本的总抗dsDNA抗体和高亲合力抗dsDNA抗体水平；采用Kappa分析探讨不同检测方法间结果的一致性；Spearman相关系数分析高亲合力dsDNA抗体与性别、年龄等临床指标的相关性。
结果在非SLE组中IIF法总抗dsDNA抗体（dsDNA-IIF）阴性，ELISA法总抗dsDNA抗体（dsDNA-ELISA）阳性的例数为15例，说明dsDNA-ELISA检测结果对SLE的特异性不高。dsDNA-IIF与dsDNA-ELISA的总体符合率为58.7%（91/155），Kappa=0.172 < 0.4，两种方法的一致性较低（P < 0.01）；而dsDNA-IIF与高亲合力抗dsDNA抗体的总体符合率为61.9%（96/155），Kappa=0.514，0.4 < Kappa < 7.5，两种方法的一致性一般（P < 0.01）。高亲合力抗dsDNA水平与dsDNA-IIF和dsDNA-ELISA水平呈正相关（P < 0.01），与性别、年龄、是否是狼疮肾炎无相关性（P>0.05）；dsDNA-IIF和高亲合力抗dsDNA抗体联合诊断敏感率为90.5%（105/116），特异性为100%（39/39）。
结论dsDNA-IIF和高亲合力抗dsDNA抗体水平的联合检测更有助于对SLE的诊断。高亲合力抗dsDNA抗体与年龄、性别和是否为狼疮性肾炎无相关性。

Abstract:
ObjectiveTo investigate the distribution of high affinity anti-double-stranded DNA(dsDNA) antibodies in patients with systemic lupus erythematosus(SLE), and its correlation with sex, age and lupus nephritis.
MethodsA total of 155 serum samples with anti-dsDNA antibody positive in Guangdong Provincial Hospital of Traditional Chinese Medicine from August 2017 to April 2018 were collected, which were divided the SLE group(116 cases) and non-SLE group(39 cases).The levels of total anti-dsDNA antibody and high affinity anti-dsDNA antibody were determined using the enzyme-linked immunosorbent assay(ELISA) and indirect immunofluorescence(IIF).The Kappa analysis was used to investigate the consistency of results among different detection methods.Spearman correlation coefficient was used to analyze the correlation between high affinity dsDNA antibody, and gender, age and other clinical indicators.
ResultsThe total anti-dsDNA antibody measured by ELISA(dsDNA-ELISA) was not specific for SLE.The overall compliance rate between dsDNA-IIF and dsDNA-ELISA was 58.7%(91/155), the Kappa was 0.172(< 0.4), and the consistency between two methods was low(P < 0.01).The overall compliance rate between dsDNA-IIF and high affinity dsDNA-ELISA was 61.9%(96/155), the Kappa was 0.514(0.4 < Kappa < 7.5), and the consistency between two methods was moderate(P < 0.01).The high affinity anti-dsDNA level was positively correlated with dsDNA-IIF and dsDNA-ELISA(P < 0.01), and was not related to the gender, age and lupus nephritis(P>0.05).The sensitivity and specificity of combined diagnosis of dsDNA-IIF and high affinity anti-dsDNA were 90.5%(105/116) and 100%(39/39), respectively.
ConclusionsThe combined diagnosis of dsDNA-IIF and high affinity antibody levels is more conducive to the diagnosis of SLE.High affinity anti-dsDNA antibodies are not associated with age, gender and lupus nephritis.

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