【作者】 刘慧慧；

【导师】 叶冬青；

【作者基本信息】 安徽医科大学 ， 流行病与卫生统计学， 2006， 硕士

【摘要】 目的 探讨核小体与抗核小体抗体家族在系统性红斑狼疮(systemic lupuserythematosus，SLE)中的致病作用，分析核小体及其抗核小体家族的水平对狼疮患者器官／系统损害的影响。 方法 以两所三甲医院住院SLE患者为病例，以健康志愿者为对照；参照系统性红斑狼疮疾病活动性指数(SLEDAI)和系统性红斑狼疮损伤指数(SLICC／ACR DI)量表，设计问卷，调查患者的一般情况、实验室检查结果和器官／系统损害情况；运用双抗夹心酶联免疫吸附实验检测系统性红斑狼疮患者和健康对照的外周血清核小体、抗核小体抗体、抗组蛋白抗体、抗dsDNA抗体的浓度。 结果 SLE患者血清核小体总体水平表现为下降，可分为核小体增高组和降低组；抗核小体抗体水平、抗dsDNA抗体水平和抗组蛋白抗体水平均高于对照组。SLE患者血清核小体浓度与抗核小体抗体家族分子之间均呈负相关，抗核小体抗体家族分子水平之间均呈正相关。SLE患者血清可溶性核小体减低组的发热、皮疹、关节痛、C3降低、血沉增高、管型、血尿、蛋白尿的检出率和肾脏损害率较核小体增高组高，疾病活动人数较核小体增高组多。抗组蛋白抗体与疾病活动度之间呈正相关。抗核小体抗体、抗组蛋白抗体、抗dsDNA抗体与SLICC／ACR DI间均呈正相关。核小体抗体阳性、抗dsDNA抗体阳性和抗组蛋白抗体阳性SLE患者的肾脏损害率均明显高于阴性组。抗核小体抗体+抗dsDNA抗体抗联合检测SLE的方案较优。 结论 核小体及其抗体家族参与了SLE的发病，在SLE的发病和器官／系统损害中发挥重要作用，尤其是与肾脏损害关系最为密切，抗核小体抗体家族对诊断SLE疾病有很高的敏感性。更多还原

【Abstract】 Objective To explore the relationship among the nucleosome, broad familiy of anti-nucleosome Ab and the pathogenesis of systemic lupus erythematosus(SLE), and to study the influence of nucleosome and broad familiy of anti-nucleosome Ab on the organ or system damage in SLE patients.Methods SLE patients were selected from two hospitals, and healthy volunteers were recruited as controls. General information, chemical examination results and data of the organ or system damage were collected by self-designed questionnaire containing the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and the Systemic Lupus International Collaborative Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI). The Serum nucleosomes, anti-nucleosome antibodies, anti-dsDNA antibodies and anti-histones antibodies were measured using Sandwich-ELISA. Results The level of serum nucleosomes of SLE patients was much lower than that of health control, serum level of nucleosomes of SLE patients were divided into decreased group and increased group. The level of serum anti-nucleosomes antibody, anti-dsDNA antibody and anti-histone antibody were much higher than that of healthy controls. Negative correlation had been found between the serum level of nucleosomes and broad familiy of anti-nucleosome Ab. Positive correlation had been found between the serum level of each broad familiy of anti-nucleosome Ab. The level of nucleosome was closely related with disease activity, some clinical manifestation and lupus nephritis among 90 SLE patients. Positive correlation had been found between the level of broad, familiy of anti-nucleosome Ab and SLICC/ACR DI. The incidence of renal disorder in broad familiy of anti-nucleosome Ab positive SLE were significantly higer than that of broad familiy of anti-nucleosome Ab negative SLE. Combination of anti-nucleosomes antibody and anti-dsDNA antibody can significantly improve the sensitivity of broad familiy of anti-nucleosome Ab in the diagnosis of SLE.更多还原