ELISA法檢測血清抗核小體抗體診斷系統性紅斑狼瘡價值的系統評價_《中國循證醫學雜志》

作者：

秦莉 , 吳麗娟 , 王蘭蘭 , 白楊娟

四川大學華西醫院實驗醫學科（成都 610041）;

關鍵詞：

抗核小體抗體診斷價值系統性紅斑狼瘡系統評價 Meta分析

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　評價ELISA法檢測血清中抗核小體抗體（anti-nucleosome antibody, AnuA）診斷系統性紅斑狼瘡（systemic lupus erythematosus, SLE）的價值。
方法　檢索MEDLINE、EMbase、Cochrane 圖書館等數據庫，檢索時間為1990~2005年，收集關于AnuA診斷SLE價值的相關研究文獻，進行質量評價，利用Cochrane協作網提供的RevMan軟件進行異質性分析，MetaDisc進行Meta分析及繪制SROC曲線。
結果　共納入文獻25篇，合計7 289例，其中經金標準確認的SLE患者2 459例，非SLE者5 030例。Meta分析結果顯示，各納入研究均存在不同程度的質量問題，導致各研究間存在高度異質性（P lt;0.000 01，I2=87.2%），合并敏感度為64.9%，95%CI 63.0%~66.8%，合并特異度為92.6%，95%CI 91.8%～93.3%；SROC曲線下面積0.918，SE 0.021 2。結果表明其平均漏診率較高（35.1%），平均誤診率較低（7.4%），有一定的診斷價值。
結論　目前ELISA法檢測抗核小體抗體診斷SLE具有一定診斷價值，可作為診斷SLE的診斷指標。

引用本文： 秦莉,吳麗娟,王蘭蘭,白楊娟. ELISA法檢測血清抗核小體抗體診斷系統性紅斑狼瘡價值的系統評價. 中國循證醫學雜志, 2007, 07(3): 204-210. doi: 復制

1.	Liu GJ, Wu TX, Kang DY. The statistical process of Meta-analysis, Modern Rehabilitation, 2003, 7(4): 538–539.
2.	Liu GJ, Wu TX. Clinical Implementation of Forest Plots in Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2004, 4(3): 198–201.
3.	Liu GJ, Wu TX. Summary ROC curve-diagnostic test method of Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2003, 3(1): 41–44.
4.	Chen P, Yan L. Study on the relationship between anti-nucleosome antibody and lupus nephritis. Shanghai Journal of Medical Laboratory Sciences, 2004, 19(4): 72–74.
5.	Wu W, Zhen FQ, Li BY, et al. A study on antinucleosome antibody and deoxyribonuclease I activity in SLE patients. Journal of Clinical Dermatology, 2004, 33(6): 83–85.
6.	Zuo XX, Li YS, Wang YP, et al. A Study on Relationship Between Antinucleosome Antibody and Systemic Lupus Erythematosus. Journal of Chinese Physician, 2005, 7(2): 191–192.
7.	Tian QW, Cu KQ, Wang XB, et al. Detection of second filial generation anti-nucleosome antibody in patients with systemic lupus erythematosus. Medical Journal of Qilu, 2003, 18(2): 91–93.
8.	Xu HX, Luo GY, He L, et al. A study for the relationship between antinucleosome autoantibodies, immunoglubine, and complement with activity of SLE. The Journal of Practical Medicine, 2005, 21(9): 931–932.
9.	Su Y, Han L, Li ZG, et al. Significance of anti-nucleosome antibodies in systemic lupus erythematosus. Chinese Journal of Rheumatology, 2003, 7(8): 474–477.
10.	Hu XF, Li XF, Xu K, et al. The value of antinucleosome autoantibodies test in diagnosing systemic SLE. Chinese Journal of Laboratory Medicine, 2005, 28(4): 113–115.
11.	Guo PE, Hui XY, Zhen XY, et al. The value of antinucleosome autoantibodies test in diagnosing systemic SLE. Chinese Journal of Rheumatology, 2003, 7(8): 500–502.
12.	Xu WD, Chen ZH, Liang DH, et al. The value of antinucleosome autoantibodies test in diagnosing systemic SLE. Journal of Zhenjiang Medical College, 2004, 14(6): 539–540.
13.	Zhong Q, Gan H, Chen P, et al. A study for the relationship between antinucleosome autoantibodies and systemic SLE. Chinese Journal of Rheumatology, 2003, 7(2): 111–113.
14.	Han F, Qi WC, Li W, et al. Significance of Anti-Chromatin Antibodies in Diagnosis of Systemic Lupus Erythematosus. Tianjin Medical Journal, 2005, 33(7): 414–415.
15.	Li YS, Zuo XX, Wang YP, et al. Diagnostic Significance of Antinucleosome Antibody for Systemic Lupus Erythematosus. Journal of Clinical Research, 2004, 21(9): 89–90.
16.	Xing JL. Study for the value of two types of authoantibody in the diagnosis of Systemic Lupus Erythematosus. Journal of Sichuan Continuing Education College of Medical Sciences, 2004, 24(1): 112–113.
17.	Yu LL, Lu XM, Zhao TE, et al. Clinical Significance of Antinucleosome antibody in systemic lupus erythematosus. Chinese Journal of Dermatology, 2005, 38(1): 5–7.
18.	Su Y, Jia RL, Li ZG, et al. Significance of combined detection of autoantibodies in systemic lupus erythematosus. Chinese Journal of Rheumatology, 2005, 9(1): 16–18.
19.	劉關鍵, 吳泰相, 康德英. Meta-分析中的統計學過程. 中國臨床康復雜志, 2003, 7(4): 538~539.
20.	劉關鍵, 吳泰相. Meta-分析的森林圖及臨床意義. 中國循證醫學雜志, 2004, 4(3): 198~201.
21.	劉關鍵, 吳泰相. 診斷性試驗的Meta 分析———SROC 曲線法介紹.中國循證醫學雜志, 2003, 3(1): 41~44.
22.	Haddouk SM, Ayed BS, Baklouti, et al. Clinical significance of antinucleosome antibodies in Tunisian systemic lupus erythematosus patients. Clin Rheumatol, 2005, 24: 219–222.
23.	Sallai K, Nagy E, Derfalvy B, et al. Antinucleosome Antibodies and Decreased Deoxyribonuclease Activity in Sera of Patients with Systemic Lupus Erythematosus. Clin Diagn Lab Immunol, 2005, 1: 56–59.
24.	Chabre H, Amoura Z, Piette JC, et al. Presence of nucleosome-restricted antibodies in patients with systemic lupus erythematosus. Arthritis & Rheumatol, 1995, 38(10): 1485–1491.
25.	陳瀑, 嚴立. 抗核小體抗體與系統性紅斑狼瘡腎炎相關性研究. 檢驗醫學, 2004, 19(4): 72~74.
26.	吳瑋, 曾凡欽, 李伯有, 等. 系統性紅斑狼瘡患者血清抗核小體抗體和脫氧核糖核酸酶I活性的研究. 臨床皮膚科雜志, 2004, 33(6): 83~85.
27.	左曉霞, 李懿莎, 王彥平, 等. 抗核小體抗體與系統性紅斑狼瘡活動性的相關研究. 中國醫師雜志, 2005, 7(2): 191~192.
28.	Sato S, Kodora M, Hasegawa M, et al. Antinucleosome antibody is a major autoantibody in localized scleroderma. Br J Dermatol, 2004, 151: 1182–1188.
29.	Julkunen H, Salonen EM, Walle TK, et al. Anti-nucleosome antibodies in the diagnosis of systemic lupus erythematosus. Scand J Rheumatol, 2005, 34: 122–124.
30.	Villalta D, Tozzoli R, Bizzaro N, et al. The relevance of autoantigen source and cutoff definition in antichromatin (nucleosome) antibody immunoassays. Ann N Y Acad Sci, 2005, 1050: 176–184.
31.	Gonzalez C, Garcia-Berrocal B, Herraez O, et al. Anti-nucleosome, anti-chromatin, anti-dsDNA and antihistone antibody reactivity in systemic lupus erythematosus. Clin Chem Lab Med, 2004, 42(3): 266–272.
32.	Ghirardello A, Doria S, Zampieri, et al. Antinucleosome antibodies in SLE: a two-year follow-up study of 101 patients. J Autoimmun, 2004, 22: 235–240.
33.	Simon JA, Cabiedes J, Ortiz E, et al. Anti-nucleosome antibodies in patients with SLE of recent onset. Rheumatology, 2004, 43: 220-224.
34.	Cervera R, Vinas O, Ramos-Casals M, et al. Anti-chromatin antibodies in SLE: a useful marker for lupus nephropathy. Ann Rheum Dis, 2003, 62–65.
35.	Cairns AP, McMillan SA, Crockard AD, et al. Antinucleosome antibodies in the diagnosis of SLE. Ann Rheum Dis, 2003, 62: 272–273.
36.	Min DJ, Kim SJ, Park SH, et al. Anti-nuclesome ab: significance in lupus patients lacking anti-double-stranded DNA antibody. Clinical and Exp Rheum, 2002, 20: 13–18.
37.	Genevieve S, Daens S, Guillaume MP, et al. Diagnostic specificities and sensitivities of anti dsDNA, anti membrane DNA and anti-nucleosomes autoantibodies. Scand J Clin Lab Invest, 2001, 61(Suppl 235): 61–67.
38.	Zahir A, Sophie K, Henri C, et al. Presence of antinucleosome autoantibodies in a restricted set of connective tissue disease Antinucleosome Antibodies of the IgG3 Subclass are Markers of Renal Pathogenicity in Systemic Lupus Erythematosus. Arthritis Rheum, 2000, 43: 76–84.
39.	Anne B, Stefan B, Gert H, et al. Nucleosme are major T and B cell autoantigens in Systemic Lupus Erythematosus. Arthritis Rheum, 2000, 43: 2307–2315.
40.	Suer W, Da hnrich C, Schlumberger W, et al. Autoantibodies in SLE but not in scleroderma react with protein-stripped nucleosomes. J Autoimmun, 2004, 22: 325–334.
41.	田清武, 初開秋, 王錫波, 等. 第二代抗核小體抗體檢測對系統性紅斑狼瘡的診斷價值. 齊魯醫學雜志, 2003, 18(2): 91~93.
42.	徐紅先, 羅貴有, 何林, 等. 抗核小體抗體、免疫球蛋白及補體與系統性紅斑狼瘡活動性的相關性研究. 實用醫學雜志, 2005, 21(9): 931~932.
43.	蘇茵, 韓蕾, 栗占國, 等. 抗核小體抗體測定在系統性紅斑狼瘡診斷中的意義. 中華風濕病學雜志, 2003, 7(8): 474~477.
44.	胡學芳, 李小峰, 許珂, 等. 抗核小體抗體對系統性紅斑狼瘡的診斷價值. 中華檢驗醫學雜志, 2005, 28(4): 113~115.
45.	郭品娥, 惠小陽, 鄭曉玉, 等. 抗核小體抗體對系統性紅斑狼瘡的診斷價值. 中華風濕病學雜志, 2003, 7(8): 500~502.
46.	徐衛東, 陳昭華, 梁德輝, 等. 抗核小體抗體檢測在系統性紅斑狼瘡診斷中的意義. 江蘇大學學報 (醫學版), 2004, 14(6): 539~540.
47.	鐘清, 甘華, 陳瀑, 等. 抗核小體抗體與系統性紅斑狼瘡的相關性研究. 中華風濕病學雜志, 2003, 7(2): 111~113.
48.	韓鋒, 齊文成, 李巍, 等. 抗核小體抗體在系統性紅斑狼瘡診斷中的應用. 天津醫藥, 2005, 33(7): 414~415.
49.	李懿莎, 左曉霞, 王彥平, 等. 抗核小體抗體在系統性紅斑狼瘡中的診斷意義. 醫學臨床研究, 2004, 21(9): 89~90.
50.	邢晉玲. 兩種自身抗體檢測對系統性紅斑狼瘡診斷價值的探討. 四川省衛生管理干部學院學報, 2004, 24(1): 112~113.
51.	袁玲玲, 盧憲梅, 趙天恩, 等. 系統性紅斑狼瘡患者血清抗核小體抗體水平檢測及其臨床意義. 中華皮膚科雜志, 2005, 38(1): 5~7.
52.	蘇茵, 賈汝琳, 栗占國, 等. 自身抗體聯合檢測在系統性紅斑狼瘡診斷中的意義. 中華風濕病學雜志, 2005, 9(1): 16~18.

1. Liu GJ, Wu TX, Kang DY. The statistical process of Meta-analysis, Modern Rehabilitation, 2003, 7(4): 538–539.
2. Liu GJ, Wu TX. Clinical Implementation of Forest Plots in Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2004, 4(3): 198–201.
3. Liu GJ, Wu TX. Summary ROC curve-diagnostic test method of Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2003, 3(1): 41–44.
4. Chen P, Yan L. Study on the relationship between anti-nucleosome antibody and lupus nephritis. Shanghai Journal of Medical Laboratory Sciences, 2004, 19(4): 72–74.
5. Wu W, Zhen FQ, Li BY, et al. A study on antinucleosome antibody and deoxyribonuclease I activity in SLE patients. Journal of Clinical Dermatology, 2004, 33(6): 83–85.
6. Zuo XX, Li YS, Wang YP, et al. A Study on Relationship Between Antinucleosome Antibody and Systemic Lupus Erythematosus. Journal of Chinese Physician, 2005, 7(2): 191–192.
7. Tian QW, Cu KQ, Wang XB, et al. Detection of second filial generation anti-nucleosome antibody in patients with systemic lupus erythematosus. Medical Journal of Qilu, 2003, 18(2): 91–93.
8. Xu HX, Luo GY, He L, et al. A study for the relationship between antinucleosome autoantibodies, immunoglubine, and complement with activity of SLE. The Journal of Practical Medicine, 2005, 21(9): 931–932.
9. Su Y, Han L, Li ZG, et al. Significance of anti-nucleosome antibodies in systemic lupus erythematosus. Chinese Journal of Rheumatology, 2003, 7(8): 474–477.
10. Hu XF, Li XF, Xu K, et al. The value of antinucleosome autoantibodies test in diagnosing systemic SLE. Chinese Journal of Laboratory Medicine, 2005, 28(4): 113–115.
11. Guo PE, Hui XY, Zhen XY, et al. The value of antinucleosome autoantibodies test in diagnosing systemic SLE. Chinese Journal of Rheumatology, 2003, 7(8): 500–502.
12. Xu WD, Chen ZH, Liang DH, et al. The value of antinucleosome autoantibodies test in diagnosing systemic SLE. Journal of Zhenjiang Medical College, 2004, 14(6): 539–540.
13. Zhong Q, Gan H, Chen P, et al. A study for the relationship between antinucleosome autoantibodies and systemic SLE. Chinese Journal of Rheumatology, 2003, 7(2): 111–113.
14. Han F, Qi WC, Li W, et al. Significance of Anti-Chromatin Antibodies in Diagnosis of Systemic Lupus Erythematosus. Tianjin Medical Journal, 2005, 33(7): 414–415.
15. Li YS, Zuo XX, Wang YP, et al. Diagnostic Significance of Antinucleosome Antibody for Systemic Lupus Erythematosus. Journal of Clinical Research, 2004, 21(9): 89–90.
16. Xing JL. Study for the value of two types of authoantibody in the diagnosis of Systemic Lupus Erythematosus. Journal of Sichuan Continuing Education College of Medical Sciences, 2004, 24(1): 112–113.
17. Yu LL, Lu XM, Zhao TE, et al. Clinical Significance of Antinucleosome antibody in systemic lupus erythematosus. Chinese Journal of Dermatology, 2005, 38(1): 5–7.
18. Su Y, Jia RL, Li ZG, et al. Significance of combined detection of autoantibodies in systemic lupus erythematosus. Chinese Journal of Rheumatology, 2005, 9(1): 16–18.
19. 劉關鍵, 吳泰相, 康德英. Meta-分析中的統計學過程. 中國臨床康復雜志, 2003, 7(4): 538~539.
20. 劉關鍵, 吳泰相. Meta-分析的森林圖及臨床意義. 中國循證醫學雜志, 2004, 4(3): 198~201.
21. 劉關鍵, 吳泰相. 診斷性試驗的Meta 分析———SROC 曲線法介紹.中國循證醫學雜志, 2003, 3(1): 41~44.
22. Haddouk SM, Ayed BS, Baklouti, et al. Clinical significance of antinucleosome antibodies in Tunisian systemic lupus erythematosus patients. Clin Rheumatol, 2005, 24: 219–222.
23. Sallai K, Nagy E, Derfalvy B, et al. Antinucleosome Antibodies and Decreased Deoxyribonuclease Activity in Sera of Patients with Systemic Lupus Erythematosus. Clin Diagn Lab Immunol, 2005, 1: 56–59.
24. Chabre H, Amoura Z, Piette JC, et al. Presence of nucleosome-restricted antibodies in patients with systemic lupus erythematosus. Arthritis & Rheumatol, 1995, 38(10): 1485–1491.
25. 陳瀑, 嚴立. 抗核小體抗體與系統性紅斑狼瘡腎炎相關性研究. 檢驗醫學, 2004, 19(4): 72~74.
26. 吳瑋, 曾凡欽, 李伯有, 等. 系統性紅斑狼瘡患者血清抗核小體抗體和脫氧核糖核酸酶I活性的研究. 臨床皮膚科雜志, 2004, 33(6): 83~85.
27. 左曉霞, 李懿莎, 王彥平, 等. 抗核小體抗體與系統性紅斑狼瘡活動性的相關研究. 中國醫師雜志, 2005, 7(2): 191~192.
28. Sato S, Kodora M, Hasegawa M, et al. Antinucleosome antibody is a major autoantibody in localized scleroderma. Br J Dermatol, 2004, 151: 1182–1188.
29. Julkunen H, Salonen EM, Walle TK, et al. Anti-nucleosome antibodies in the diagnosis of systemic lupus erythematosus. Scand J Rheumatol, 2005, 34: 122–124.
30. Villalta D, Tozzoli R, Bizzaro N, et al. The relevance of autoantigen source and cutoff definition in antichromatin (nucleosome) antibody immunoassays. Ann N Y Acad Sci, 2005, 1050: 176–184.
31. Gonzalez C, Garcia-Berrocal B, Herraez O, et al. Anti-nucleosome, anti-chromatin, anti-dsDNA and antihistone antibody reactivity in systemic lupus erythematosus. Clin Chem Lab Med, 2004, 42(3): 266–272.
32. Ghirardello A, Doria S, Zampieri, et al. Antinucleosome antibodies in SLE: a two-year follow-up study of 101 patients. J Autoimmun, 2004, 22: 235–240.
33. Simon JA, Cabiedes J, Ortiz E, et al. Anti-nucleosome antibodies in patients with SLE of recent onset. Rheumatology, 2004, 43: 220-224.
34. Cervera R, Vinas O, Ramos-Casals M, et al. Anti-chromatin antibodies in SLE: a useful marker for lupus nephropathy. Ann Rheum Dis, 2003, 62–65.
35. Cairns AP, McMillan SA, Crockard AD, et al. Antinucleosome antibodies in the diagnosis of SLE. Ann Rheum Dis, 2003, 62: 272–273.
36. Min DJ, Kim SJ, Park SH, et al. Anti-nuclesome ab: significance in lupus patients lacking anti-double-stranded DNA antibody. Clinical and Exp Rheum, 2002, 20: 13–18.
37. Genevieve S, Daens S, Guillaume MP, et al. Diagnostic specificities and sensitivities of anti dsDNA, anti membrane DNA and anti-nucleosomes autoantibodies. Scand J Clin Lab Invest, 2001, 61(Suppl 235): 61–67.
38. Zahir A, Sophie K, Henri C, et al. Presence of antinucleosome autoantibodies in a restricted set of connective tissue disease Antinucleosome Antibodies of the IgG3 Subclass are Markers of Renal Pathogenicity in Systemic Lupus Erythematosus. Arthritis Rheum, 2000, 43: 76–84.
39. Anne B, Stefan B, Gert H, et al. Nucleosme are major T and B cell autoantigens in Systemic Lupus Erythematosus. Arthritis Rheum, 2000, 43: 2307–2315.
40. Suer W, Da hnrich C, Schlumberger W, et al. Autoantibodies in SLE but not in scleroderma react with protein-stripped nucleosomes. J Autoimmun, 2004, 22: 325–334.
41. 田清武, 初開秋, 王錫波, 等. 第二代抗核小體抗體檢測對系統性紅斑狼瘡的診斷價值. 齊魯醫學雜志, 2003, 18(2): 91~93.
42. 徐紅先, 羅貴有, 何林, 等. 抗核小體抗體、免疫球蛋白及補體與系統性紅斑狼瘡活動性的相關性研究. 實用醫學雜志, 2005, 21(9): 931~932.
43. 蘇茵, 韓蕾, 栗占國, 等. 抗核小體抗體測定在系統性紅斑狼瘡診斷中的意義. 中華風濕病學雜志, 2003, 7(8): 474~477.
44. 胡學芳, 李小峰, 許珂, 等. 抗核小體抗體對系統性紅斑狼瘡的診斷價值. 中華檢驗醫學雜志, 2005, 28(4): 113~115.
45. 郭品娥, 惠小陽, 鄭曉玉, 等. 抗核小體抗體對系統性紅斑狼瘡的診斷價值. 中華風濕病學雜志, 2003, 7(8): 500~502.
46. 徐衛東, 陳昭華, 梁德輝, 等. 抗核小體抗體檢測在系統性紅斑狼瘡診斷中的意義. 江蘇大學學報 (醫學版), 2004, 14(6): 539~540.
47. 鐘清, 甘華, 陳瀑, 等. 抗核小體抗體與系統性紅斑狼瘡的相關性研究. 中華風濕病學雜志, 2003, 7(2): 111~113.
48. 韓鋒, 齊文成, 李巍, 等. 抗核小體抗體在系統性紅斑狼瘡診斷中的應用. 天津醫藥, 2005, 33(7): 414~415.
49. 李懿莎, 左曉霞, 王彥平, 等. 抗核小體抗體在系統性紅斑狼瘡中的診斷意義. 醫學臨床研究, 2004, 21(9): 89~90.
50. 邢晉玲. 兩種自身抗體檢測對系統性紅斑狼瘡診斷價值的探討. 四川省衛生管理干部學院學報, 2004, 24(1): 112~113.
51. 袁玲玲, 盧憲梅, 趙天恩, 等. 系統性紅斑狼瘡患者血清抗核小體抗體水平檢測及其臨床意義. 中華皮膚科雜志, 2005, 38(1): 5~7.
52. 蘇茵, 賈汝琳, 栗占國, 等. 自身抗體聯合檢測在系統性紅斑狼瘡診斷中的意義. 中華風濕病學雜志, 2005, 9(1): 16~18.

《中國循證醫學雜志》

ELISA法檢測血清抗核小體抗體診斷系統性紅斑狼瘡價值的系統評價

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《中國循證醫學雜志》

ELISA法檢測血清抗核小體抗體診斷系統性紅斑狼瘡價值的系統評價

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摘要全文圖表視頻參考文獻施引文獻補充材料