[1]王 娇,杜利君,赵 佳,等.系统性红斑狼疮患者ANA 免疫荧光核型分布及其与病情发展的相关性研究[J].现代检验医学杂志,2023,38(06):42-47+130.[doi:10.3969/j.issn.1671-7414.2023.06.008]
　WANG Jiao,DU Lijun,ZHAO Jia,et al.Correlation between ANA Immunofluorescence Karyotype Distribution and Disease Development in Patients with Systemic Lupus Erythematosus[J].Journal of Modern Laboratory Medicine,2023,38(06):42-47+130.[doi:10.3969/j.issn.1671-7414.2023.06.008]
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系统性红斑狼疮患者ANA 免疫荧光核型分布及其与病情发展的相关性研究()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第38卷
期数:
2023年06期
页码:
42-47+130
栏目:
论著
出版日期:
2023-11-15

文章信息/Info

Title:
Correlation between ANA Immunofluorescence Karyotype Distribution and Disease Development in Patients with Systemic Lupus Erythematosus
文章编号:
1671-7414（2023）06-042-07
作者:
王 娇; 杜利君; 赵 佳; 张 兵
（四川省南充市中心医院检验科，四川南充 637000）
Author(s):
WANG Jiao;  DU Lijun;  ZHAO Jia;  ZHANG Bing
（Department of Clinical Laboratory, Nanchong Central Hospital, Sichuan Nanchong 637000, China）
关键词:
系统性红斑狼疮; 抗核抗体; 免疫荧光核型
分类号:
R593.241；R392.11
DOI:
10.3969/j.issn.1671-7414.2023.06.008
文献标志码:
A
摘要:
目的 研究系统性红斑狼疮（systemic lupus erythematosus，SLE）患者抗核抗体（antinuclear antibody，ANA）免疫荧光核型分布特征及其与病情发展的相关性。方法 选取2018 年8 月～ 2022 年8 月期间于四川省南充市中心医院收治的300 例SLE 患者作为SLE 组，以同期收治的50 例非SLE 的其他自身免疫性疾病患者作为非SLE 组、健康体检的50 例健康人群作为健康对照组。应用多重微珠流式免疫荧光发光法检测血清ANA 阳性表达情况，应用间接免疫荧光（indirect immunofluorescence，IIF）法检测ANA 免疫荧光核型，比较三组ANA 阳性率，分析不同临床特征SLE患者ANA 阳性率、ANA 免疫荧光核型分布情况。根据SLE 患者病情发展情况分为SLE 活动组111 例、SLE 非活动组189 例，比较两组ANA 阳性率和免疫荧光核型分布情况，采用受试者工作（receiver operating characteristic，ROC）曲线分析ANA 预测SLE 患者病情发展的价值，经二元Logistic 回归分析影响SLE 患者病情发展的危险因素，采用Spearman 法分析ANA 与SLE 患者病情发展的相关性。结果 健康对照组、非SLE 组和SLE 组ANA 阳性率（4.00%，56.00%，96.00%）依次升高，差异具有统计学意义（χ2=171.500，P ＜ 0.05）。ANA 阳性率与SLE 患者有关节炎、病情发展有关（P ＜ 0.05）。288 例ANA 阳性SLE 患者免疫荧光核型包括核颗粒型[60.07%（173/288）]、核均质型[31.94%（92/288）]、胞浆颗粒型[3.47%（10/288）]、核仁型[2.78%（8/288）] 和着丝点型[1.74%（5/288）]，以核颗粒型最为多见，其次为核均质型。与SLE 非活动组比较，SLE 活动组ANA 阳性率（99.10% vs 94.18%）、ANA 免疫荧光核型中核颗粒型比例（69.37% vs 50.79%）升高，差异具有统计学意义（χ2=4.407，9.884，均P ＜ 0.05）。与SLE非活动组比较，SLE 活动组肾脏病变比例、SLEDAI 评分、IgA 水平、IgM 水平和IgG 水平升高，而C3 水平和C4 水平降低，差异具有统计学意义（t/χ2=10.793 ～ 96.751，均P ＜ 0.05）。由Logistic 回归分析结果构建预测模型：Logit（P）=1.854×（ANA 阳性）+1.872×（ANA 核颗粒型）+1.278×（SLEDAI 评分）+1.651×（IgA）+1.795×（IgM）+1.885×（IgG）+1.684×（C3）+1.463×（C4）+1.221×（肾脏病变）-10.797。经ROC 曲线分析显示，预测模型预测活动期SLE 的曲线下面积为0.895（95%CI：0.800 ～ 0.943），高于ANA 预测[0.785（95%CI：0.714 ～ 0.844）]。相关性分析显示，ANA 表达与SLE 患者病情发展呈正相关关系（r=0.309，P ＜ 0.05）。结论 SLE 患者ANA 阳性率升高，免疫荧光核型分布以核颗粒型常见，与患者病情发展有关，可用于SLE 病情发展的评估。
Abstract:
Objective To study the distribution characteristics of antinuclear antibodies (ANA) immunofluorescence karyotypes in patients with systemic lupus erythematosus (SLE) and their correlation with the development of the patient’s condition. Methods 300 SLE patients admitted to Nanchong Central Hospital in Sichuan Province from August 2018 to August 2022 were selected as the SLE group, 50 patients with other autoimmune diseases other than SLE admitted in the same period were selected as the non SLE group, and 50 healthy people in health examination were selected as the healthy control group. Multiple bead flow immunofluorescence luminescence method was used to detect the positive expression of serum ANA, and indirect immunofluorescence (IIF) method was used to detect ANA immunofluorescence karyotypes. Three groups of ANA positive rates were compared, and the ANA positive rates and distribution of ANA immunofluorescence karyotypes in SLE patients with different clinical characteristics were analyzed. According to the disease activity of SLE patients, 111 cases were divided into SLE active group and 189 cases were SLE inactive group. The positive rate of ANA and the distribution of immunofluorescence karyotypes were compared between the two groups. The receiver operating characteristic (ROC) was used to analyze the value of ANA in predicting the progression of SLE patients, and binary logistic regression was used to analyze the risk factors affecting the progression of SLE patients. The Spearman method was used to analyze the correlation between ANA and the progression of SLE patients. Results The ANA positive rates (4.00%, 56.00%, 96.00%) in the healthy control group, non SLE group, and SLE group increased sequentially, with statistically significant differences（ χ2=171.500, P<0.05). The positive rate of ANA was associated with arthritis and disease progression in SLE patients (P < 0.05). The immunofluorescence karyotypes of 288 ANA positive SLE patients included nuclear granular type [60.07% (173/288)], nuclear homogeneous type [31.94% (92/288)], cytoplasmic granular type [3.47% (10/288)], nucleolar type [2.78% (8/288)] and centrocentric type [1.74% (5/288) )], the nuclear granular type was the most common, followed by the nuclear homogeneous type. Compared with inactive SLE group, the positive rate of ANA (99.10% vs 94.18%) and the proportion of nuclear particle type in ANA immunofluorescence karyotype (69.37% vs 50.79%) were significantly higher in active SLE group (χ2=4.407, 9.884, all P < 0.05). Compared with the inactive SLE group, the proportion of kidney lesions, SLEDAI score, IgA, IgM, IgG levels, C3, C4 levels were increased in the active SLE group, and the differences were statistically significant (t/χ2=10.793 ～ 96.751，all P < 0.05). The prediction model was constructed by Logistic regression analysis results: Logit (P) =1.854×(ANA positive) +1.872×(ANA granulotype) +1.278×(SLEDAI score) +1.651×(IgA) +1.795×(IgM) +1.885×(IgG) +1.684×(C3) +1.463×(C4) +1.221×(Kidney disease)-10.797. ROC curve analysis showed that the area under the curve of SLE predicted by the prediction model was 0.895 （95%CI：0.800 ~ 0.943）, which was higher than ANA prediction[0.785（95%CI：0.714 ～ 0.844）]. Correlation analysis showed that ANA expression was positively correlated with the development of SLE patients (P < 0.05). Conclusion ANA positive rate increases in SLE patients, and the distribution of immunofluorescent karyotypes was common with nuclear granules, which was related to the disease development of patients and can be used for the assessment of the disease development of SLE.

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备注/Memo

备注/Memo:
基金项目：四川省卫生健康委员会科研课题（普及应用项目）（编号：18PJ123）: 南充地区检验危急值管理调查分析及其规范作用。
作者简介：王娇 (1991-)，女，硕士，主管技师，研究方向：临床免疫学检验，E-mail：wj15182929761@163.com。
通讯作者：张兵 (1970-)，男，博士，副主任技师，研究方向：临床免疫学检验，E-mail：3221454931@qq.com。
更新日期/Last Update: 2023-11-15