中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
17期
1989-1993
,共5页
崔婵娟%柏明见%冯珍如%闫存玲%李志艳%牛飞
崔嬋娟%柏明見%馮珍如%閆存玲%李誌豔%牛飛
최선연%백명견%풍진여%염존령%리지염%우비
红斑狼疮,系统性%狼疮肾炎%抗C1q抗体%补体C3%补体C4
紅斑狼瘡,繫統性%狼瘡腎炎%抗C1q抗體%補體C3%補體C4
홍반랑창,계통성%랑창신염%항C1q항체%보체C3%보체C4
Lupus erythematosus,systemic%Lupus nephritis%Anti - C1q%Complement C3%Complement C4
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。
目的：探討血清抗 C1q 抗體與繫統性紅斑狼瘡（SLE）活動性及狼瘡性腎炎（LN）病理分型的關繫，揭示抗 C1q 抗體在輔助診斷 SLE、LN 及評判其活動性中的臨床價值。方法選取2012年12月-2013年8月在北京大學第一醫院門診就診及住院的 SLE 患者120例〔SLE 組，包括59例 LN 患者（LN 組）和61例非 LN 患者（非 LN 組）；61例活動期患者（活動組）和59例緩解期患者（緩解組）〕、其他自身免疫病患者100例（疾病對照組）及體檢健康者120例（健康對照組）。採用 ELISA 法檢測血清抗 C1q 抗體。比較各組抗 C1q 抗體情況，併與抗 dsDNA 抗體、補體及 SLE 疾病活動指數（SLEDAI）進行相關性分析。結果 SLE 組血清抗 C1q 抗體暘性率〔35.8%（43/120）〕高于疾病對照組〔12.0%（12/100）〕和健康對照組〔5.0%（6/120）〕（P ﹤0.017）。SLE 活動組患者血清抗 C1q 抗體暘性率及水平高于緩解組〔49.2%（30/61）與22.0%（13/59），P ﹤0.05；11.68（3.19，19.37） U/ ml 與3.76（1.93，8.28）U/ ml，P ﹤0.05〕；SLE 輕、中、重度活動組患者抗 C1q 抗體暘性率及水平間均無差異（P ﹥0.05）。LN 組 SLE患者血清抗 C1q 抗體暘性率高于非 LN 組〔50.8%（30/59）與21.3%（13/61），P ﹤0.05〕。Ⅳ型 LN 患者血清抗 C1q抗體暘性率高于Ⅱ﹢Ⅲ型〔68.8%（22/32）與23.5%（4/17），P ﹤0.017〕。血清抗 C1q 抗體診斷 LN 的敏感度〔50.85%（37.64%，63.95%）〕低于抗 dsDNA 抗體〔69.49%（55.98%，80.46%）〕，但其特異度高于抗 dsDNA 抗體〔78.69%（65.98%，87.74%）與57.38%（44.10%，69.73%）〕。抗 C1q 抗體及抗 dsDNA 抗體聯閤檢測診斷 LN的特異度提高至88.52%（77.17%，94.88%）。血清抗 C1q 抗體與SLEDAI、抗 dsDNA 抗體水平呈正相關（r 值分彆為0.293和0.305，均 P ﹤0.01），與補體 C3、C4呈負相關（r 值分彆為-0.290和-0.283，均 P ﹤0.01）。結論血清抗C1q 抗體可作為一種簡便、特異、無創的生物標記物，能客觀反映 SLE 疾病活動性，有效指導 LN 病理分型，尤其是Ⅳ型 LN。血清抗 C1q 抗體與抗 dsDNA 抗體聯閤檢測可提高 LN 診斷的特異度。
목적：탐토혈청항 C1q 항체여계통성홍반랑창（SLE）활동성급랑창성신염（LN）병리분형적관계，게시항 C1q 항체재보조진단 SLE、LN 급평판기활동성중적림상개치。방법선취2012년12월-2013년8월재북경대학제일의원문진취진급주원적 SLE 환자120례〔SLE 조，포괄59례 LN 환자（LN 조）화61례비 LN 환자（비 LN 조）；61례활동기환자（활동조）화59례완해기환자（완해조）〕、기타자신면역병환자100례（질병대조조）급체검건강자120례（건강대조조）。채용 ELISA 법검측혈청항 C1q 항체。비교각조항 C1q 항체정황，병여항 dsDNA 항체、보체급 SLE 질병활동지수（SLEDAI）진행상관성분석。결과 SLE 조혈청항 C1q 항체양성솔〔35.8%（43/120）〕고우질병대조조〔12.0%（12/100）〕화건강대조조〔5.0%（6/120）〕（P ﹤0.017）。SLE 활동조환자혈청항 C1q 항체양성솔급수평고우완해조〔49.2%（30/61）여22.0%（13/59），P ﹤0.05；11.68（3.19，19.37） U/ ml 여3.76（1.93，8.28）U/ ml，P ﹤0.05〕；SLE 경、중、중도활동조환자항 C1q 항체양성솔급수평간균무차이（P ﹥0.05）。LN 조 SLE환자혈청항 C1q 항체양성솔고우비 LN 조〔50.8%（30/59）여21.3%（13/61），P ﹤0.05〕。Ⅳ형 LN 환자혈청항 C1q항체양성솔고우Ⅱ﹢Ⅲ형〔68.8%（22/32）여23.5%（4/17），P ﹤0.017〕。혈청항 C1q 항체진단 LN 적민감도〔50.85%（37.64%，63.95%）〕저우항 dsDNA 항체〔69.49%（55.98%，80.46%）〕，단기특이도고우항 dsDNA 항체〔78.69%（65.98%，87.74%）여57.38%（44.10%，69.73%）〕。항 C1q 항체급항 dsDNA 항체연합검측진단 LN적특이도제고지88.52%（77.17%，94.88%）。혈청항 C1q 항체여SLEDAI、항 dsDNA 항체수평정정상관（r 치분별위0.293화0.305，균 P ﹤0.01），여보체 C3、C4정부상관（r 치분별위-0.290화-0.283，균 P ﹤0.01）。결론혈청항C1q 항체가작위일충간편、특이、무창적생물표기물，능객관반영 SLE 질병활동성，유효지도 LN 병리분형，우기시Ⅳ형 LN。혈청항 C1q 항체여항 dsDNA 항체연합검측가제고 LN 진단적특이도。
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.
