Antiribosomal P protein antibodies in cerebrospinal fluid are associated with neuropsychiatric systemic lupus erythematosus.
Antiribosomal P protein antibodies in cerebrospinal fluid are associated with neuropsychiatric systemic lupus erythematosus.
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发表时间：
2005
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通讯作者：
T. Yoshio;D. Hirata;K. Onda;H. Nara;S. Minota
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作者：
T. Yoshio;D. Hirata;K. Onda;H. Nara;S. Minota
目的探讨系统性红斑狼疮（SLE）患者脑脊液（CSF）中是否存在抗核糖体P蛋白抗体（anti-P），以及CSF中抗P抗体的存在是否比血清中抗P抗体与神经精神系统性红斑狼疮（NPSLE）的关系更密切。方法收集70例SLE患者的脑脊液和血清标本。患者分为4组：21例中枢神经系统（CNS）神经综合征患者; 19例弥漫性精神/神经心理综合征患者; 10例复杂表现（CNS神经综合征加弥漫性精神/神经心理综合征）患者; 20例无NPSLE患者，基于美国风湿病学会提出的19种NPSLE综合征诊断标准。用大鼠肝核糖体免疫印迹法检测脑脊液和血清中IgG抗P。使用5份与合成核糖体P肽预孵育的抗P阳性CSF样本进行抑制试验。将Western blotting结果与以合成核糖体P肽为抗原的ELISA结果进行比较。分析脑脊液及血清抗P抗体与NPSLE的关系。结果70例患者脑脊液和血清中分别有20例（28.6%）和32例（45.7%）检测到抗P抗体。抑制试验中的阳性结果支持CSF中通过Western印迹法检测的IgG抗P的存在，并且与ELISA法检测的CSF IgG抗P滴度显著相关。免疫印迹法检测抗P抗体阳性的SLE患者CSF中抗P抗体阳性率明显高于无抗P抗体阳性的SLE患者（18/32比2/38; P < 0.001）。NPSLE患者脑脊液抗P抗体阳性率明显高于非NPSLE患者（19/50 vs 1/20; p < 0.01）。免疫印迹法检测脑脊液抗P抗体的频率在复杂表现组（10/10）显著高于其他3组[CNS神经系统综合征（5/21）;弥漫性精神/神经心理综合征（4/19）;无NPSLE患者（1/20）]（p < 0.001）。通过蛋白质印迹法检测，NPSLE患者血清抗P的频率并不明显高于无NPSLE患者（25/50 vs 7/20; p = 0.192）。结论SLE患者脑脊液中IgG抗P抗体的存在可能参与了NPSLE的发生，尤其是复杂表现的NPSLE。免疫印迹法检测脑脊液中IgG抗P抗体可能比血清中IgG抗P抗体更有助于诊断NPSLE。
OBJECTIVE To investigate whether antiribosomal P protein antibodies (anti-P) are present in the cerebrospinal fluid (CSF) of patients with systemic lupus erythematosus (SLE), and if presence of anti-P in CSF is more strongly related to the appearance of neuropsychiatric SLE (NPSLE) than anti-P in serum. METHODS CSF and serum samples from 70 patients with SLE were used. Patients were divided into 4 groups: 21 patients with neurologic syndromes of the central nervous system (CNS); 19 patients with diffuse psychiatric/neuropsychological syndromes; 10 patients with complex presentations (neurologic syndromes of the CNS plus diffuse psychiatric/neuropsychological syndromes); and 20 patients without NPSLE based on diagnostic criteria for 19 NPSLE syndromes proposed by the American College of Rheumatology. IgG anti-P in CSF and serum samples were detected by Western blotting using rat liver ribosomes. Inhibition assay was performed using 5 anti-P-positive CSF samples preincubated with synthetic ribosomal P peptide. Western blotting results were compared with those from ELISA with synthetic ribosomal P peptide as antigen. The association of CSF and serum anti-P with NPSLE was analyzed. RESULTS CSF and serum IgG anti-P by Western blotting were detected, respectively, in 20 (28.6%) and 32 (45.7%) of 70 patients. The presence of IgG anti-P by Western blotting in the CSF was supported by positive results in the inhibition assay and significant association with CSF IgG anti-P titers by ELISA. The frequency of CSF anti-P by Western blotting in SLE patients with serum anti-P was significantly higher than in SLE patients without serum anti-P (18/32 vs 2/38; p < 0.001). The frequency of CSF anti-P by Western blotting in patients with NPSLE was significantly higher than in patients without NPSLE (19/50 vs 1/20; p < 0.01). The frequency of CSF anti-P by Western blotting in the group with complex presentations (10/10) was significantly higher than in the other 3 groups [neurologic syndromes of CNS (5/21); diffuse psychiatric/neuropsychological syndromes (4/19); and patients without NPSLE (1/20)] (p < 0.001). The frequency of serum anti-P by Western blotting in patients with NPSLE was not significantly higher than in patients without NPSLE (25/50 vs 7/20; p = 0.192). CONCLUSION These results suggest that the presence of IgG anti-P in CSF of SLE patients may be involved in the appearance of NPSLE, especially in complex presentations. Measurement of IgG anti-P in CSF by Western blotting may be more useful for diagnosis of NPSLE than measurements in serum.