【摘要】 目的研究抗肾小球基底膜(GBM)抗体的抗原决定簇及其与临床病理表现的关系。方法用辣根过氧化物酶标记的亲和层析纯化的抗GBM自身抗体(APab-HRP)和抗α1、3、5(IV)NC1单克隆抗体(Mab1、3、5)作为识别GBM上不同抗原决定簇的探针,应用竞争性ELISA法测定抗GBM抗体的抗原决定簇。结果59例患者中,58(98.3%)例可抑制Mab3,20(33.9%)例可抑制Mab1,均不抑制Mab5。同一血清对APab-HRP和对Mab3的抑制率呈平行关系(P<0.01)。不同患者血清抗体对APab-HRP的抑制率与该患者确诊时的血肌酐浓度呈正相关(P<0.05)。出现少尿或无尿的患者血清抗体对APab-HRP的抑制率较高(P<0.01)。单纯抗GBM抗体阳性组较合并ANCA阳性组对APab-HRP的抑制率较高(P<0.05)。是否出现咯血、肾脏病理新月体所占比例、肾转归以及其他临床表现不同的患者,对各种探针的抑制率均无差异。结论抗GBM抗体的主要抗原决定簇位于α3(IV)NC1,但并不完全一致。抗原决定簇的差异可能与肾损害的程度相关。更多还原

【Abstract】 Objective To investigate the epitopes of antiglomerular basement membrane(GBM) antibodies and their association with clinical and pathological parameters.Methods Serum from 59 patients with anti-GBM disease were applied to inhibit monoclonal antibody against 1,3, 5(IV) NC1(Mab1,Mab3 and Mab5) and purified,horseradish peroxidase conjugated,human anti-GBM antibodies(APab-HRP) was used in competite inhibitory ELISA.The inhibition rates were evaluated and compared among patients with different clinical manifestations.Results All 59 samples inhibited APab-HRP,58/59 sample inhibited Mab3,20/59 sample inhibited Mab1,and none of them inhibited Mab5.The inhibition rates for APab-HRP and Mab3 were parallel.A significant correlation was observed between the inhibition rates for APab-HRP and levels of serum creatinine on diagnosis(P<0.05).The inhibition rates for APab-HRP in patients with oligo-anuria were higher than those without oligo-anuria(P<0.01).The mean inhibition rates for APab-HRP were(37.4±9.2)% in patients with anti-GBM antibodies only and(30.9±12.5)% in patients with both anti-GBM antibodies and ANCA(P<0.05).No correlation was found between the inhibition rates for APab-HRP,Mab1 and Mab3 and age,gender,pulmonary hemorrhage,renal outcome and other clinical data.Conclusion Anti-GBM antibodies from all patients could recognize major epitopes on 3(IV)NC1 with individual variation.Epitopes on 3(IV)NC1 might be associated with the severity of renal damage.更多还原