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目的研究抗组氨酰-tRNA合成酶(Jo-1)抗体、抗干燥综合征(SS)-A抗体、抗SS-B抗体等非特异性抗体及抗核糖核蛋白(RNP)抗体、抗双链DNA(dsDNA)抗体、抗Sm抗体等特异性抗体在儿童系统性红斑狼疮(SLE)诊断中的意义,并与抗核抗体(ANA)的敏感性和特异性进行比较。探讨特异性自身抗体联合检测在儿童SLE诊断中的意义。方法选取60例SLE患儿作为疾病组,40例非SLE自身免疫性疾病患儿作为对照组。利用间接荧光法测定ANA抗体,免疫印迹法测定抗Jo-1抗体、抗SS-A抗体、抗SS-B抗体、抗RNP抗体、抗dsDNA抗体、抗Sm抗体。结果 ANA抗体、抗dsDNA抗体、抗RNP抗体、抗Sm抗体、抗SS-A抗体、抗SS-B抗体在儿童SLE患者中的阳性率分别为96.7%、48.3%、31.7%、30.0%、20.0%、18.3%,与对照组比较(22.5%、10.0%、7.5%、5.0%、5.0%、5.0%),差异均有统计学意义(P<0.01)。ANA的敏感性显著高于其他3种抗体,而其他3种抗体的特异性明显高于ANA;抗dsD-NA抗体、抗RNP抗体、抗Sm抗体的特异性分别为95.0%、92.5%、95.0%,差异有统计学意义(P<0.05);抗dsDNA抗体与抗RNP抗体、抗Sm抗体均无相关性。自身抗体的联合检测对儿童SLE敏感性的提高有明显的改善,但对特异性的提高则无明显改变。结论抗dsDNA抗体、抗RNP抗体、抗Sm抗体在儿童SLE诊断中特异性较高,而敏感性差异较大,其中抗dsDNA抗体的敏感性最高。此3种特异性抗体在SLE诊断中的互补作用显著。自身抗体的联合检测可明显提高SLE诊断的敏感性。
Objective To study the expression of anti-His-1, Anti-Sjogren’s syndrome (SS) -A and anti-SS-B antibodies and anti-ribonucleoprotein DNA (dsDNA) antibodies, anti-Sm antibodies and other specific antibodies in the diagnosis of childhood systemic lupus erythematosus (SLE), and compared with the antinuclear antibody (ANA) sensitivity and specificity. To explore the significance of combined detection of specific autoantibodies in children with SLE. Methods Sixty children with SLE were selected as disease group and 40 children with non-SLE autoimmune disease as control group. Anti-Jo-1 antibody, anti-SS-A antibody, anti-SS-B antibody, anti-RNP antibody, anti-dsDNA antibody and anti-Sm antibody were determined by indirect immunofluorescence assay. Results The positive rates of ANA antibody, anti-dsDNA antibody, anti-RNP antibody, anti-Sm antibody, anti-SS-A antibody and anti-SS-B antibody in children with SLE were 96.7%, 48.3%, 31.7%, 30.0% %, 18.3%, respectively. Compared with the control group (22.5%, 10.0%, 7.5%, 5.0%, 5.0%, 5.0%), the difference was statistically significant (P <0.01). The sensitivity of ANA was significantly higher than that of the other three antibodies, while the specificity of the other three antibodies was significantly higher than that of ANA. The specificity of anti-dsD-NA antibody, anti-RNP antibody and anti-Sm antibody were 95.0%, 92.5% and 95.0 %, The difference was statistically significant (P <0.05); anti-dsDNA antibody and anti-RNP antibody, anti-Sm antibody had no correlation. The combined detection of autoantibodies improved the sensitivity of children with SLE significantly, but no significant change of specificity. Conclusion The anti-dsDNA antibody, anti-RNP antibody and anti-Sm antibody are highly specific in the diagnosis of children with SLE, but their sensitivity is quite different. The anti-dsDNA antibody has the highest sensitivity. The three kinds of specific antibodies in the diagnosis of SLE significant complementarity. Joint detection of autoantibodies significantly improves the diagnostic sensitivity of SLE.