ELISA法联合CLIFT法检测抗双链DNA-IgG抗体应用于系统性红斑狼疮的诊断价值

doi:10.16150/j.1671-2870.2018.06.007

摘要/Abstract

摘要： 目的：采用酶联免疫吸附试验（enzyme-linked immunosorbent assay, ELISA）, 观察抗双链DNA（double-stranded DNA, dsDNA）IgG抗体在系统性红斑狼疮（systemic lupus erythematosus, SLE）患者和非SLE患者中的分布特点, 并评估ELISA法联合绿蝇短膜虫间接免疫荧光试验（crithidia luciliae immunofluorescence test, CLIFT）检测抗dsDNA-IgG抗体用于SLE诊断的效能。方法：收集上海交通大学医学院附属瑞金医院检测抗dsDNA-IgG抗体的住院患者的临床资料, 共4 726例采用ELISA法, 其中830例同时采用CLIFT检测, 用受试者工作特征曲线（receiver operating characteristic curve, ROC）分析2种检测方法辅助诊断SLE的效能。结果：采用ELISA法检测的 4 726例住院患者中, dsDNA抗体阳性者398例, 其中SLE 183例, 占dsDNA 阳性者46.0%, 非 SLE疾病依次为肝脏疾病（28.4%）、其他结缔组织病（7.5%）、血液系统疾病（5.3%）及呼吸系统疾病（3.8%）;830例采用CLIFT检测ds DNA, 134例结果显示为dsDNA抗体阳性的患者中, 其中SLE者占94.0%, 另有非SLE诊断病例包括自身免疫性肝病3例, 肝硬化、肾炎、银屑病和抗磷脂综合征各1例。830例完成ELISA法与CLIFT双检测的患者中, SLE患者共197例, 非SLE患者633例, ELISA法检测灵敏度为74.6%, 特异度仅为92.9%;而CLIFT法测dsDNA抗体具有较高的特异度, 为98.7%, 灵敏度为64.0%。联合2种方法平行检测dsDNA抗体可明显提高SLE的诊断效能, ROC曲线下面积最高（0.869 0）。结论：单独应用ELISA法时, 应警惕假阳性较高, 需排除其他非SLE疾病的诊断;联合使用ELISA法和CLIFT法检测抗dsDNA抗体可较单独应用CLIFT法明显提高SLE的诊断效能, 二者联合平行检测结果为阴性, 用于排除SLE更有意义。

关键词: 抗dsDNA-IgG抗体, 系统性红斑狼疮, 绿蝇短膜虫间接免疫荧光, 酶联免疫吸附试验

Abstract: Objective: To analyze the occurrence of anti-double-stranded DNA (dsDNA) IgG antibody in SLE (systemic lupus erythematosus) and non-SLE patients and the efficacy of combined use of ELISA and CLIFT (crithidia luciliae immunofluorescence test) in detection of anti-dsDNA IgG antibody for diagnosis of SLE. Methods: The clinical data of 4 726 patients undergoing anti-dsDNA IgG antibody detection by ELISA and 830 of them receiving CLIFT were collected. Receiver operating characteristic curve (ROC) was used to evaluate the performance of each or combined use of the two in detection of anti-dsDNA IgG antibody for the diagnosing of SLE. Results: Among the 4 726 patients tested by ELISA, 398 cases were anti-dsDNA IgG antibody positive. Of them 183 patients were diagnosed as SLE (46.0%). The non-SLE patients included liver disease (28.4%), other connective tissue diseases (7.5%), hematological disease(5.3%) and respiratory di-sease(3.8%). For 830 cases undergoing CLIFT, 134 cases were anti-dsDNA IgG antibody positive, and 94% of them were diagnosed as SLE; the non-SLE patients included 3 cases of autoimmune liver disease, 1 case of liver cirrhosis, 1 case of nephritis, 1 case of psoriasis and 1 case of anti-phospholipid syndrome. In the cohort of 830 patient with both detection of anti-dsDNA IgG antibody by both ELISA and CLIFT, 197 patients were diagnosed as SLE, and 633 patients diagnosed as non-SLF. ELISA had a sensitivity of 74.6% and a specificity of 92.9%, while CLIFT had a specificity of 98.7% and a sensitivity of 64%. The combined detection by ELISA and CLIFT could significantly improve the efficacy of diagnosing SLE, with the highest AUC of 0.8 690. Conclusions: When ELISA is applied alone for detection of anti-dsDNA IgG antibody,a high false positivity should be paid attention to. The detection of anti-dsDNA IgG antibody by both ELISA and CLIFT could significantly improve the diagnostic efficacy for SLE than by CLIFT alone.

Key words: Anti-dsDNA IgG antibody, Systemic lupus erythematosus, Indirect immunofluorescence test, Enzyme-linked immunosorbent assay

中图分类号:

R593

葛建华, 龚文, 施新明, 巩惠芸, 马龙新, 周劲峰, 石慧. ELISA法联合CLIFT法检测抗双链DNA-IgG抗体应用于系统性红斑狼疮的诊断价值[J]. 诊断学理论与实践, 2018, 17(06): 658-663.

GE Jianhua, GONG Wen, SHI Xinming, GONG Huiyun, MA Longxin, ZHOU Jinfeng, SHI Hui. Value of combining ELISA and CLIFT in detection of anti-dsDNA IgG antibody for diagnosis of systemic lupus erythematosis[J]. Journal of Diagnostics Concepts & Practice, 2018, 17(06): 658-663.

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