中华皮肤科杂志 ›› 2004, Vol. 37 ›› Issue (9): 509-511.

• 论著 • 上一篇    下一篇

抗不同细胞核成分抗体与SLE病情活动不相关

金丽威, 鲁智勇, 郑捷   

  1. 第二医科大学附属瑞金医院皮肤科、风湿科, 上海200025
  • 收稿日期:2003-09-27 出版日期:2004-09-15 发布日期:2004-09-15

Levels of Various Anti-nuclear Component Antibodies in Patients with SLE are not Correlated with the Disease Activity

JIN Li-wei, LU Zhi-yong, ZHENG Jie   

  1. Department of Dermatology and Rheumatology, Rui Jin Hospital of Shanghai Second Medical University, Shanghai 200025, China
  • Received:2003-09-27 Online:2004-09-15 Published:2004-09-15

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摘要： 目的 探讨系统性红斑狼疮(SLE)患者ANA、抗ds-DNA抗体及其他抗细胞核成分抗体水平与SLE病情的相关性。方法 选取2000-2002年我院皮肤与风湿科、肾内科住院及门诊就诊的SLE患者225例进行回顾性研究。用SLE疾病活动性指数(SLEDAI)进行病情活动性评分,按SLEDAI评分将患者分为轻度活动组(≤4分)、中度活动组(5~9分)及重度活动组(≥10分)3组。并对其中52例患者进行追踪观察。结果 ①225例患者抗dsDNA抗体水平和ANA滴度与SLEDAI无相关性(r1=0.054、P1=0.662,r2=0.089、P2=0.183)。②抗ds-DNA抗体水平在轻度活动组与中度活动组之间差异无显著性(P>0.05),重度活动组明显高于轻度活动组与中度活动组(P<0.01)。ANA滴度在3组之间差异均无显著性。抗Sm抗体、抗RNP抗体、抗SSA、SSB抗体的阳性率在3组之间差异均无显著性(P>0.05)。③根据抗ds-DNA抗体结合率将患者分为<20%(第1组)、≥20%(第2组)两组,两组SLE脑病、肺部病变、浆膜炎、血管炎、关节炎、血象异常的发生率差异无显著性(P>0.05),第2组肾脏损害的发生率高于第1组(P<0.05),但这些有肾脏损害的患者蛋白尿、肌酐水平与抗ds-DNA均无相关性(P>0.05)。④追踪观察52例中30例高度活动组患者抗ds-DNA抗体水平在治疗前高于治疗后(P<0.05),而22例轻、中度活动组抗ds-DNA水平在治疗前后差异无显著性(P>0.05).结论在重度活动组,抗ds-DNA抗体水平与SLE疾病活动有一定相关性;在稳定期,与疾病无相关性.ANA等其他自身抗体与SLE疾病活动无相关性.虽然抗ds-DNA抗体结合率≥20%的患者易伴有肾损害,但与严重程度无相关性.

关键词: 红斑狼疮, 系统性, 抗体, 抗核

Abstract: Objective To investigate the correlation between the disease activity and the serum levels of anti-nuclear autoantibodies against various nuclear components in the patients with systemic lupus erythematosus (SLE). Methods Two hundred and twenty five SLE patients enrolled from 2000 to 2002 were evaluated retrospectively. All patients fulfilled the ACR 1997 diagnostic criteria for SLE. The patients were divided into three groups according to the disease activity: mild group (Group A), moderate group (Group B)and severe group (Group C), as assessed with SLEDAI score. These cases were also divided into 2 groups according to the serum levels of anti-dsDNA antibody. 52 out of 225 patients were followed up further. Results ①There was no correlation between the serum level of anti-dsDNA antibody and SLEDAI score, and between the serum level of ANA and SLEDAI score in 225 patients. ②The serum level of anti-dsDNA antibody in group C was higher than that in group A or group B (P<0.01), and without significant difference between group A and group B. And, there were no significant differences between the three groups both in the serum levels of ANA and in the positive rates of ENA antibodies (anti-Sm、anti-SSA/SSB、anti- RNP antibody). ③225 patients were divided into two groups according to the serum level of anti-dsDNA antibody: < 20% (Group 1), ≥20% (Group 2). The occurrence of renal damage in group 2 was higher than that in group 1 (P<0.05). However, there was no significant difference between these two groups in the level of proteinuria or serum creatinine. ④In the fifty-two patients followed up, 30 patients with severe disease activity, the serum level of anti-dsDNA antibody decreased after treatment (P<0.05), but no difference was shown in other 22 patients with mild to moderate disease activity (P>0.05). Conclusions A positive correlation between the anti-dsDNA antibody and the disease activity was found in the severe group of SLE, but not found in the mild or moderate group. Although the renal damage was more commonly seen in those with higher level of anti-dsDNA antibody, but there is no correlation between the level of anti-dsDNA antibody and the degree of renal lesion.

Key words: Lupus erythematosus, systemic, Antibodies, antinuclear