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血清抗 C1q 抗体在评价系统性红斑狼疮活动性及狼疮性肾炎病理分型中的临床意义
其他题名Clinical Significance of the Serum Anti - C1q Antibody in Evaluating the Activity of Systemic Lupus Erythematosus and the Pathological Type of Lupus Renal
崔婵娟; 柏明见; 冯珍如; 闫存玲; 李志艳; 牛飞
关键词狼疮肾炎 红斑狼疮 抗c1q抗体 系统性 补体c3 补体c4 Lupus Nephritis Lupus Erythematosus Anti - C1q Systemic Complement C3 Complement C4
刊名中国全科医学
2014
DOI10.3969/j.issn.1007-9572.2014.17.016
17页:1989-1993
收录类别中国科技核心期刊 ; 中文核心期刊 ; CSCD
文章类型Journal Article
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 ca-ses with LN(LN group)and 61 cases without LN(non - LN group);61 active patients(active group)and 59 remission pa-tients(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 com-pared in these different groups,and were analyzed with anti - dsDNA antibody,complement and SLEDAI. Results The posi-tive 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 - C1q antibody were both not significant in SLE different active groups(P ﹥ 0. 05). The positive rate of anti - C1q 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 - C1q 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- C1q 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 - C1q 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 - C1q antibody and anti - ds-DNA antibody were combined detection,the specificity in diagnosis of LN could be increased to 88. 52% ( 77. 17% , 94. 88% ). The serum anti - C1q 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 - C1q 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 - C1q antibody and anti - dsDNA antibody combined can improve LN diag-nostic specificity.
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文献类型期刊论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/43557
专题北京大学第一临床医学院_检验科
作者单位北京大学第一医院检验科, 北京市,100034
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崔婵娟,柏明见,冯珍如,等. 血清抗 C1q 抗体在评价系统性红斑狼疮活动性及狼疮性肾炎病理分型中的临床意义[J]. 中国全科医学,2014(17):1989-1993.
APA 崔婵娟,柏明见,冯珍如,闫存玲,李志艳,&牛飞.(2014).血清抗 C1q 抗体在评价系统性红斑狼疮活动性及狼疮性肾炎病理分型中的临床意义.中国全科医学(17),1989-1993.
MLA 崔婵娟,et al."血清抗 C1q 抗体在评价系统性红斑狼疮活动性及狼疮性肾炎病理分型中的临床意义".中国全科医学 .17(2014):1989-1993.
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