Autoantibodies in systemic lupus erythematosus: comparison of historical and current assessment of seropositivity
Autoantibodies in systemic lupus erythematosus: comparison of historical and current assessment of seropositivity
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DOI：
10.1177/0961203310385738
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发表时间：
2011-03-01
期刊：
影响因子：
2.6
通讯作者：
Petri, M.
中科院分区：
文献类型：
--
作者：
Ippolito, A.;Wallace, D. J.;Petri, M.
系统性红斑狼疮(SLE)以多种自身抗体和补体活化为特征。最近的研究表明，在一些SLE患者中，抗核抗体(ANA)阳性可能会随着时间的推移而消失。抗双链DNA(DsDNA)抗体滴度和补体水平可能会随时间和免疫抑制治疗而变化，而抗可提取核抗原(ENA)随时间的变化则不太清楚。这项研究试图确定系统性红斑狼疮患者历史自身抗体检测和当前检测之间的相关性。从美国系统性红斑狼疮重新分类数据库(ROSE)中选择302例具有历史和当前实验室数据的系统性红斑狼疮患者进行分析。将实验室的历史数据与目前在参考实验室进行的自身抗体测试进行比较，并使用百分比一致性和Kappa统计进行一致性检验。血清学检查包括ANA、抗dsDNA、抗Smith、抗核糖核蛋白(RNP)、抗Ro、抗La、类风湿因子(RF)、补体C3、补体C4。在那些免疫学标志物历来阴性的人中，参考实验室目前对这些标志物的评估通常产生低百分比的额外阳性(3-13%)。然而，在历史上ANA阴性的患者中，有6/11(55%)被参考实验室检测为阳性，参考实验室检测还发现抗RNP患者增加了20%，RF患者增加了18%。在那些免疫学标志物历史阳性的患者中，同一实验室检测的参考实验室结果一般为阳性(范围为57%至97%)。然而，在那些有低C3或C4病史的人中，目前的参考实验室结果显示低C3或C4的比例很低(分别为18%和39%)。与之前的研究相反，随着时间的推移，ANA的阳性率仍然是积极的。随着时间的推移，抗Ro、La、RNP、Smith和抗dsDNA抗体基本一致，而补体的一致性较低。这种差异可以部分解释为历史化验的可变性，这些化验是由当地实验室在不同的时间段进行的。然而，补体结果的差异更有可能是由治疗反应来解释的。这些发现值得在诊断和临床试验登记的背景下加以考虑。狼疮(2011)20,250-255。
Systemic lupus erythematosus (SLE) is characterized by multiple autoantibodies and complement activation. Recent studies have suggested that anti-nuclear antibody (ANA) positivity may disappear over time in some SLE patients. Anti-double-stranded DNA (dsDNA) antibody titers and complement levels may vary with time and immunosuppressive treatment, while the behavior of anti-extractable nuclear antigen (ENA) over time is less well understood. This study sought to determine the correlation between historical autoantibody tests and current testing in patients with SLE. Three hundred and two SLE patients from the ACR Reclassification of SLE (AROSE) database with both historical and current laboratory data were selected for analysis. The historical laboratory data were compared with the current autoantibody tests done at the reference laboratory and tested for agreement using percent agreement and Kappa statistic. Serologic tests included ANA, anti-dsDNA, anti-Smith, anti-ribonucleoprotein (RNP), anti-Ro, anti-La, rheumatoid factor (RF), C3 and C4. Among those historically negative for immunologic markers, a current assessment of the markers by the reference laboratory generally yielded a low percentage of additional positives (3-13%). However, 6/11 (55%) of those historically negative for ANA were positive by the reference laboratory, and the reference laboratory test also identified 20% more patients with anti-RNP and 18% more with RF. Among those historically positive for immunologic markers, the reference laboratory results were generally positive on the same laboratory test (range 57% to 97%). However, among those with a history of low C3 or C4, the current reference laboratory results indicated low C3 or C4 a low percentage of the time (18% and 39%, respectively). ANA positivity remained positive over time, in contrast to previous studies. Anti-Ro, La, RNP, Smith and anti-dsDNA antibodies had substantial agreement over time, while complement had less agreement. This variation could partially be explained by variability of the historical assays, which were done by local laboratories over varying periods of time. Variation in the results for complement, however, is more likely to be explained by response to treatment. These findings deserve consideration in the context of diagnosis and enrolment in clinical trials. Lupus (2011) 20, 250-255.