The predictive value of fluctuations in IgM and IgG class anti-dsDNA antibodies for relapses in systemic lupus erythematosus. A prospective long term observation
The predictive value of fluctuations in IgM and IgG class anti-dsDNA antibodies for relapses in systemic lupus erythematosus. A prospective long term observation
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DOI：
10.1136/ard.56.11.661
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发表时间：
1997-11-01
影响因子：
27.4
通讯作者：
Kallenberg, CGM
中科院分区：
文献类型：
--
作者：
Bootsma, H;Spronk, PE;Kallenberg, CGM
目的探讨抗双链DNA(抗dsDNA)IgM类抗体升高对系统性红斑狼疮(SLE)复发的预测价值。此外，还分析了IgM类抗双链DNA抗体的升高是否与系统性红斑狼疮的特定临床表现有关。方法-对72例研究开始时或复发时IgM类抗双链DNA阳性的SLE患者中的34例在19.6个月的中位观察期内每月分析类特异性抗双链DNA水平。根据SLE疾病活动性指数对疾病活动性进行评分，用IgM和Ig G类抗体的酶联免疫吸附试验(ELISA法)和PAR法检测抗dsDNA抗体。其中22例(85%)复发者同时伴有IgM类抗双链DNA抗体阳性，23例(89%)Ig G类抗双链DNA阳性，25例(96%)FARR复发者IBG类双链DNA或PARR试验抗双链DNA阳性，其累积复发率显著高于未升高者(P=0.04和P=0.03)。而IgM类抗dsDNA抗体的升高则不是如此(p=0.16)。此外，复发前IgM类抗双链DNA抗体的升高与系统性红斑狼疮的特殊临床表现无关，以优势比表示。IgM类抗双链DNA抗体的升高与Ig G类抗双链DNA抗体的升高相比，不是预测复发的敏感指标，且与SLE的特殊临床表现无关。
Objective-This study investigated the predictive value of rises in IgM class antibodies against double stranded DNA (anti-dsDNA) for ensuing relapses in systemic lupus erythematosus (SLE) in comparison with rises in IgG class antibodies. In addition, it was analysed whether rises in IgM class anti-dsDNA were associated with specific clinical manifestations of SLE.Methods-Thirty four of a cohort of 72 SLE patients who were positive for IgM class anti-dsDNA at the start of the study or at the time of a relapse were analysed monthly for class specific anti-dsDNA levels during a median observation period of 19.6 months. Disease activity was scored according to the SLE Disease Activity Index, Anti-dsDNA were measured by IgM and IgG class enzyme linked immunosorbent assay (ELISA) and by Parr assay.Results-During the study 18 of 34 patients experienced 26 relapses. Twenty two (85%) of the relapses were accompanied by a positive test for IgM class anti-dsDNA by ELISA, 23 (89%) were positive for IgG class anti-dsDNA by ELISA, and 25 (96%) were positive by Farr Patients with rises in IBG class dsDNA by ELISA or in anti-dsDNA by Parr assay had a significantly higher cumulative risk for relapses than patients without those increases (p=0.04 and p=0.03, respectively). This was not the case for rises in IgM class anti-dsDNA (p=0.16). Moreover, a rise in IgM class anti-dsDNA before a relapse was not associated, expressed in terms of odds ratios, with specific clinical manifestations of SLE.Conclusion-Relapses of SLE are frequently accompanied by IgM class anti-dsDNA. Rises of IgM class anti-dsDNA, in contrast with rises in IgG class anti-dsDNA, are not a sensitive tool for predicting a relapse and are not associated with specific clinical manifestations of SLE.