抗可提取性核抗原抗体与系统性红斑狼疮临床表现和疾病活动度的相关性研究
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摘要
目的探讨抗可提取性核抗原(ENAs)抗体与系统性红斑狼疮(SLE)患者的临床表现和疾病活动指数的相关性。方法共纳入201例SLE患者(女性192例),记录其一般情况、临床表现和抗ENAs等实验室检查结果,使用SLE活动指数(SLEDAI)和英岛狼疮评定组评定表(BILAG)2种评估方法评价疾病活动度。结果抗SSA抗体与头痛(r=0.26,P=0.04)、视物模糊(r=0.31,P=0.02)、皮疹(r=0.39,P=0.01)、脱发(r=0.23,P=0.04)、口腔溃疡(r=0.37,P=0.04)和SLEDAI(r=0.27,P=0.03)呈正相关,与C3呈负相关(r=-0.29,P=0.003);抗SSA抗体与抗SSB抗体呈正相关(r=0.69,P<0.01),但与抗dsDNA、抗RNP和抗Sm抗体无相关性。抗SSB抗体与头痛(r=0.34,P=0.02)、视物模糊(r=0.27,P=0.04)、SLEDAI(r=0.36,P=0.02)和BILAG血管炎评分(r=0.23,P=0.03)呈正相关,与C3(r=-0.27,P=0.007)呈负相关;抗SSB抗体与抗RNP抗体或抗Sm抗体无相关性。抗Sm抗体与疾病病程(r=0.16,P=0.001)、肾炎(r=0.32,P=0.02)、尿蛋白定量(24 h)(r=0,23,P=0.004)、SLEDAI(r=0.37,P=0.004)和BILAG肾脏评分(r=0.31,P=0.01)呈正相关,并且与发病年龄(r=-0.31,P=0.02)、白细胞(r=-0.35,P=0.01)和C4(r=-0.23,P=0.04)呈负相关。抗RNP抗体与雷诺现象(r=0.32,P=0.04)、抗dsDNA抗体(r=0.46,P=0.007)和BILAG皮肤黏膜评分(r=0.33,P=0.01)呈正相关,与白细胞(r=-0.27,P=0.03)呈负相关。在多变量分析中,抗SSA抗体与头痛、视物模糊和C3仍相关,抗SSB抗体与C3和头痛仍相关。抗Sm抗体与疾病病程和总SLEDAI评分相关,而抗RNP抗体仅与BILAG黏膜皮肤评分相关。结论抗ENAs抗体与SLE的临床表现相关,并与疾病活动度相关,提示检测抗ENAs不仅可以反映SLE患者的临床表现,且其在疾病活动的评估方面起重要作用。
Objective To investigate the correlation between anti-extractable nuclear antigens(anti-ENAs) antibodies and clinical manifestations and disease activity in patients with systemic lupus erythematosus(SLE). Methods A total of 201 SLE patients(192 females) were included in the study. The general conditions, clinical manifestations,and laboratory results of anti-ENAs were recorded. The disease activity was assessed by SLE disease activity index(SLEDAI) and British Isles Lupus Assessment Group(BILAG) Scale. Results Anti-SSA was positively correlated with headache(r=0.26, P=0.04), blurring of vision(r=0.31, P=0.02), rash(r=0.39, P=0.01), hair loss(r=0.23, P=0.04), oral ulcer(r=0.37, P=0.04), SLEDAI(r=0.27, P=0.03), and negatively correlated with C3(r=-0.29, P=0.003). Anti-SSA was positively correlated with anti SSB antibody(r=0.69, P<0.01), but showed no correlation with anti-dsDNA, antiRNP and anti-Sm antibodies. Anti-SSB antibody was positively correlated with headache(r=0.34, P=0.02), blurring of vision(r=0.27, P=0.04), SLEDAI(r=0.36, P=0.02) and BILAG vasculitis score(r=0.23, P=0.03), and negatively correlated with C3(r=-0.27, P=0.007). Anti-SSB was not correlated with anti-RNP or anti-Sm antibodies. Anti-Sm antibody was positively correlated with disease course(r =0.16, P =0.001), nephritis(r =0.32, P =0.02), 24-hour urine protein quantification(r=0.23, P=0.004), SLEDAI(r=0.37, P=0.004), BILAG renal score(r=0.31, P=0.01), and negatively correlated with age of onset(r=-0.31, P=0.02), WBC(r=-0.35, P=0.01) and C4(r=-0.23, P=0.04). Anti-RNP antibody was positively correlated with Raynaud′s phenomenon(r=0.32, P=0.04), anti-dsDNA(r=0.46, P=0.007), BILAG mucocutaneous score(r=0.33, P=0.01), and negatively correlated with WBC(r=-0.27, P=0.03). In multivariate analysis, anti-SSA/Ro antibody was still correlated with headache, blurring of vision and C3, and anti-SSB/La antibody was still correlated with C3 and headache. Anti-Sm antibody was correlated with disease course and total SLEDAI score,whereas anti-RNP antibody was only correlated with BILAG mucocutaneous score. Conclusion: Anti-ENAs antibodies are correlated with clinical manifestations and disease activity of SLE, suggesting that examination of anti-ENAs not only reflects the clinical manifestations of SLE, but also significantly favors the assessment of disease activity.
Objective To investigate the correlation between anti-extractable nuclear antigens(anti-ENAs) antibodies and clinical manifestations and disease activity in patients with systemic lupus erythematosus(SLE). Methods A total of 201 SLE patients(192 females) were included in the study. The general conditions, clinical manifestations,and laboratory results of anti-ENAs were recorded. The disease activity was assessed by SLE disease activity index(SLEDAI) and British Isles Lupus Assessment Group(BILAG) Scale. Results Anti-SSA was positively correlated with headache(r=0.26, P=0.04), blurring of vision(r=0.31, P=0.02), rash(r=0.39, P=0.01), hair loss(r=0.23, P=0.04), oral ulcer(r=0.37, P=0.04), SLEDAI(r=0.27, P=0.03), and negatively correlated with C3(r=-0.29, P=0.003). Anti-SSA was positively correlated with anti SSB antibody(r=0.69, P<0.01), but showed no correlation with anti-dsDNA, antiRNP and anti-Sm antibodies. Anti-SSB antibody was positively correlated with headache(r=0.34, P=0.02), blurring of vision(r=0.27, P=0.04), SLEDAI(r=0.36, P=0.02) and BILAG vasculitis score(r=0.23, P=0.03), and negatively correlated with C3(r=-0.27, P=0.007). Anti-SSB was not correlated with anti-RNP or anti-Sm antibodies. Anti-Sm antibody was positively correlated with disease course(r =0.16, P =0.001), nephritis(r =0.32, P =0.02), 24-hour urine protein quantification(r=0.23, P=0.004), SLEDAI(r=0.37, P=0.004), BILAG renal score(r=0.31, P=0.01), and negatively correlated with age of onset(r=-0.31, P=0.02), WBC(r=-0.35, P=0.01) and C4(r=-0.23, P=0.04). Anti-RNP antibody was positively correlated with Raynaud′s phenomenon(r=0.32, P=0.04), anti-dsDNA(r=0.46, P=0.007), BILAG mucocutaneous score(r=0.33, P=0.01), and negatively correlated with WBC(r=-0.27, P=0.03). In multivariate analysis, anti-SSA/Ro antibody was still correlated with headache, blurring of vision and C3, and anti-SSB/La antibody was still correlated with C3 and headache. Anti-Sm antibody was correlated with disease course and total SLEDAI score,whereas anti-RNP antibody was only correlated with BILAG mucocutaneous score. Conclusion: Anti-ENAs antibodies are correlated with clinical manifestations and disease activity of SLE, suggesting that examination of anti-ENAs not only reflects the clinical manifestations of SLE, but also significantly favors the assessment of disease activity.
引文
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[9]项光博.抗SmD1抗体与系统性红斑狼疮病人疾病活动及狼疮肾炎的关系[D].温州:温州医科大学,2016.
[10]Li WG,Ye ZZ,Yin ZH,et al.Clinical and immunological charac teristics in 552 systemic lupus erythematosus patients in a south ern province of China[J].Int J Rheum Dis,2017,20:68-75.
[2]赵江峰,王楷文,王晓栋,等.系统性红斑狼疮患者抗双链DNA抗体四种检测方法的比较研究[J].中华风湿病学杂志,2017,21(6):381-386.
[3]Agarwal S,Harper J,Kiely PD.Concentration of antibodies to extractable nuclear antigens and disease activity in systemic lupus erythematosus[J].Lupus,2009,18(5):407-412.
[4]Hoffman IE,Peene I,Meheus L,et al.Specific antinuclear antibodies are associated with clinical features in systemic lupus erythematosus[J].Ann Rheum Dis,2004,63(9):1155-1158.
[5]Tapanes FJ,Vasquez M,Ramirez R,et al.Cluster analysis of antinuclear autoantibodies in the prognosis of SLE nephropathy:are anti-extractable nuclear antibodies protective?[J].Lupus,2000,9(6):437-444.
[6]Au EY,Ip WK,Lau CS,et al.Evaluation of a multiplex flow immunoassay versus conventional assays in detecting autoantibodies in systemic lupus erythematosus[J].Hong Kong Med,2018,24(3):261-269.
[7]Riboldi P,Gerosa M,Moroni G,et al.Anti-DNA antibodies:a diagnostic and prognostic tool for systemic lupus erythematosus[J].Autoimmuntity,2005,38(1):39-45.
[8]Ahn SS,Yoo BW,Song JJ,et al.Anti-Sm is associated with the early poor outcome of lupus nephritis[J].Int J Rheum Dis,2016,19(9):897-902.
[9]项光博.抗SmD1抗体与系统性红斑狼疮病人疾病活动及狼疮肾炎的关系[D].温州:温州医科大学,2016.
[10]Li WG,Ye ZZ,Yin ZH,et al.Clinical and immunological charac teristics in 552 systemic lupus erythematosus patients in a south ern province of China[J].Int J Rheum Dis,2017,20:68-75.