Autoantibodies and neuropsychiatric events at the time of systemic lupus erythematosus diagnosis
Autoantibodies and neuropsychiatric events at the time of systemic lupus erythematosus diagnosis
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DOI：
10.1002/art.23218
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发表时间：
2008-03-01
影响因子：
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通讯作者：
Merrill, J. T.
中科院分区：
文献类型：
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作者：
Hanly, J. G.;Urowitz, M. B.;Merrill, J. T.
Objective.在系统性红斑狼疮（SLE）患者的初始队列中，研究神经精神（NP）事件与抗核糖体P（抗P）、抗磷脂（狼疮抗凝剂[LAC]、抗心磷脂）、抗β 2-糖蛋白I和抗NR 2谷氨酸受体抗体之间的关系。使用美国流变学学会病例定义确定NP事件，并将其聚类为中央/外周和弥漫性/局灶性事件。使用不同严格性的决策规则确定NP事件对SLE的归因。在不了解NP事件或其属性的情况下测量自身抗体。研究了412例患者（87.4%为女性;平均+/- SD年龄34.9 ± 13.5岁，平均+/- SD病程5.0 ± 4.2个月）。133例患者（32.3%）发生了214起NP事件。归因于SLE的NP事件比例为15%至36%。总体而言，自身抗体与NP事件之间无相关性。然而，抗P抗体在SLE所致中枢神经系统疾病患者中的频率为4/20（20%），而在其他神经系统疾病患者中为3/107（2.8%），在无神经系统疾病患者中为24/279（8.6%）（P = 0.04）。在发生弥漫性NP事件的患者中，11例患者中有3例（27%）有抗P抗体，而111例发生其他NP事件的患者中有4例（3.6%），279例无NP事件的患者中有24例（8.6%）（P 0.02）。发现抗P抗体与SLE所致精神病（P = 0.02）以及LAC与SLE所致脑血管疾病（P = 0.038）之间存在特定的临床血清学相关性。其他自身抗体与NP事件无明显相关性。临床上不同的NP事件归因于系统性红斑狼疮和周围的诊断时间被发现与抗P抗体和LAC。这表明存在不同的自身免疫性发病机制，尽管低灵敏度限制了这些抗体检测的临床应用。
Objective. To examine, in an inception cohort of systemic lupus erythematosus (SLE) patients, the association between neuropsychiatric (NP) events and anti-ribosomal P (anti-P), antiphospholipid (lupus anticoagulant [LAC], anticardiolipin), anti-beta 2-glycoprotein I, and anti-NR2 glutamate receptor antibodies.Methods. NP events were identified using the American College of Rheumatology case definitions and clustered into central/peripheral and diffuse/focal events. Attribution of NP events to SLE was determined using decision rules of differing stringency. Autoantibodies were measured without knowledge of NP events or their attribution.Results. Four hundred twelve patients were studied (87.4% female; mean +/- SD age 34.9 +/- 13.5 years, mean +/- SD disease duration 5.0 +/- 4.2 months). There were 214 NP events in 133 patients (32.3%). The proportion of NP events attributed to SLE varied from 15% to 36%. There was no association between autoantibodies and NP events overall. However, the frequency of anti-P antibodies in patients with central NP events attributed to SLE was 4 of 20 (20%), versus 3 of 107 (2.8%) in patients with other NP events and 24 of 279 (8.6%) in those with no NP events (P = 0.04). Among patients with diffuse NP events, 3 of 11 had anti-P antibodies (27%), compared with 4 of 111 patients with other NP events (3.6%) and 24 of 279 of those with no NP events (8.6%) (P 0.02). Specific clinical-serologic associations were found between anti-P and psychosis attributed to SLE (P = 0.02) and between LAC and cerebrovascular disease attributed to SLE (P = 0.038). There was no significant association between other autoantibodies and NP events.Conclusion. Clinically distinct NP events attributed to SLE and occurring around the time of diagnosis were found to be associated with anti-P antibodies and LAC. This Suggests that there are different autoimmune pathogenetic mechanisms, although low sensitivity limits the clinical application of testing for these antibodies.