• 四川大學(xué)華西醫(yī)院實驗醫(yī)學(xué)科（成都 610041）;

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(tǒng)性紅斑狼瘡（systemic lupus erythematosus, SLE）的價值。
方法 　檢索MEDLINE、EMbase、Cochrane 圖書館等數(shù)據(jù)庫，檢索時間為1990~2005年，收集關(guān)于AnuA診斷SLE價值的相關(guān)研究文獻，進行質(zhì)量評價，利用Cochrane協(xié)作網(wǎng)提供的RevMan軟件進行異質(zhì)性分析，MetaDisc進行Meta分析及繪制SROC曲線。
結(jié)果 　共納入文獻25篇，合計7 289例，其中經(jīng)金標(biāo)準(zhǔn)確認(rèn)的SLE患者2 459例，非SLE者5 030例。Meta分析結(jié)果顯示，各納入研究均存在不同程度的質(zhì)量問題，導(dǎo)致各研究間存在高度異質(zhì)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(jié)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(jié)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(biāo)。

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(tǒng)性紅斑狼瘡價值的系統(tǒng)評價. 中國循證醫(yī)學(xué)雜志, 2007, 07(3): 204-210. doi: 復(fù)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(guān)鍵, 吳泰相, 康德英. Meta-分析中的統(tǒng)計學(xué)過程. 中國臨床康復(fù)雜志, 2003, 7(4): 538~539.
20. 劉關(guān)鍵, 吳泰相. Meta-分析的森林圖及臨床意義. 中國循證醫(yī)學(xué)雜志, 2004, 4(3): 198~201.
21. 劉關(guān)鍵, 吳泰相. 診斷性試驗的Meta 分析———SROC 曲線法介紹.中國循證醫(yī)學(xué)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(yán)立. 抗核小體抗體與系統(tǒng)性紅斑狼瘡腎炎相關(guān)性研究. 檢驗醫(yī)學(xué), 2004, 19(4): 72~74.
26. 吳瑋, 曾凡欽, 李伯有, 等. 系統(tǒng)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(tǒng)性紅斑狼瘡活動性的相關(guān)研究. 中國醫(yī)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(tǒng)性紅斑狼瘡的診斷價值. 齊魯醫(yī)學(xué)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(tǒng)性紅斑狼瘡活動性的相關(guān)性研究. 實用醫(yī)學(xué)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(tǒng)性紅斑狼瘡診斷中的意義. 中華風(fēng)濕病學(xué)雜志, 2003, 7(8): 474~477.
44. 胡學(xué)芳, 李小峰, 許珂, 等. 抗核小體抗體對系統(tǒng)性紅斑狼瘡的診斷價值. 中華檢驗醫(yī)學(xué)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(tǒng)性紅斑狼瘡的診斷價值. 中華風(fēng)濕病學(xué)雜志, 2003, 7(8): 500~502.
46. 徐衛(wèi)東, 陳昭華, 梁德輝, 等. 抗核小體抗體檢測在系統(tǒng)性紅斑狼瘡診斷中的意義. 江蘇大學(xué)學(xué)報 (醫(yī)學(xué)版), 2004, 14(6): 539~540.
47. 鐘清, 甘華, 陳瀑, 等. 抗核小體抗體與系統(tǒng)性紅斑狼瘡的相關(guān)性研究. 中華風(fēng)濕病學(xué)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(tǒng)性紅斑狼瘡診斷中的應(yīng)用. 天津醫(yī)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(tǒng)性紅斑狼瘡中的診斷意義. 醫(yī)學(xué)臨床研究, 2004, 21(9): 89~90.
50. 邢晉玲. 兩種自身抗體檢測對系統(tǒng)性紅斑狼瘡診斷價值的探討. 四川省衛(wèi)生管理干部學(xué)院學(xué)報, 2004, 24(1): 112~113.
51. 袁玲玲, 盧憲梅, 趙天恩, 等. 系統(tǒng)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(lián)合檢測在系統(tǒng)性紅斑狼瘡診斷中的意義. 中華風(fēng)濕病學(xué)雜志, 2005, 9(1): 16~18.
  1. 1. Liu GJ, Wu TX, Kang DY. The statistical process of Meta-analysis, Modern Rehabilitation, 2003, 7(4): 538–539.
  2. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 19. 劉關(guān)鍵, 吳泰相, 康德英. Meta-分析中的統(tǒng)計學(xué)過程. 中國臨床康復(fù)雜志, 2003, 7(4): 538~539.
  20. 20. 劉關(guān)鍵, 吳泰相. Meta-分析的森林圖及臨床意義. 中國循證醫(yī)學(xué)雜志, 2004, 4(3): 198~201.
  21. 21. 劉關(guān)鍵, 吳泰相. 診斷性試驗的Meta 分析———SROC 曲線法介紹.中國循證醫(yī)學(xué)雜志, 2003, 3(1): 41~44.
  22. 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. 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. 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. 25. 陳瀑, 嚴(yán)立. 抗核小體抗體與系統(tǒng)性紅斑狼瘡腎炎相關(guān)性研究. 檢驗醫(yī)學(xué), 2004, 19(4): 72~74.
  26. 26. 吳瑋, 曾凡欽, 李伯有, 等. 系統(tǒng)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. 27. 左曉霞, 李懿莎, 王彥平, 等. 抗核小體抗體與系統(tǒng)性紅斑狼瘡活動性的相關(guān)研究. 中國醫(yī)師雜志, 2005, 7(2): 191~192.
  28. 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. 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. 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. 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. 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. 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. 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. 35. Cairns AP, McMillan SA, Crockard AD, et al. Antinucleosome antibodies in the diagnosis of SLE. Ann Rheum Dis, 2003, 62: 272–273.
  36. 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. 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. 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. 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. 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. 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(tǒng)性紅斑狼瘡的診斷價值. 齊魯醫(yī)學(xué)雜志, 2003, 18(2): 91~93.
  42. 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(tǒng)性紅斑狼瘡活動性的相關(guān)性研究. 實用醫(yī)學(xué)雜志, 2005, 21(9): 931~932.
  43. 43. 蘇茵, 韓蕾, 栗占國, 等. 抗核小體抗體測定在系統(tǒng)性紅斑狼瘡診斷中的意義. 中華風(fēng)濕病學(xué)雜志, 2003, 7(8): 474~477.
  44. 44. 胡學(xué)芳, 李小峰, 許珂, 等. 抗核小體抗體對系統(tǒng)性紅斑狼瘡的診斷價值. 中華檢驗醫(yī)學(xué)雜志, 2005, 28(4): 113~115.
  45. 45. 郭品娥, 惠小陽, 鄭曉玉, 等. 抗核小體抗體對系統(tǒng)性紅斑狼瘡的診斷價值. 中華風(fēng)濕病學(xué)雜志, 2003, 7(8): 500~502.
  46. 46. 徐衛(wèi)東, 陳昭華, 梁德輝, 等. 抗核小體抗體檢測在系統(tǒng)性紅斑狼瘡診斷中的意義. 江蘇大學(xué)學(xué)報 (醫(yī)學(xué)版), 2004, 14(6): 539~540.
  47. 47. 鐘清, 甘華, 陳瀑, 等. 抗核小體抗體與系統(tǒng)性紅斑狼瘡的相關(guān)性研究. 中華風(fēng)濕病學(xué)雜志, 2003, 7(2): 111~113.
  48. 48. 韓鋒, 齊文成, 李巍, 等. 抗核小體抗體在系統(tǒng)性紅斑狼瘡診斷中的應(yīng)用. 天津醫(yī)藥, 2005, 33(7): 414~415.
  49. 49. 李懿莎, 左曉霞, 王彥平, 等. 抗核小體抗體在系統(tǒng)性紅斑狼瘡中的診斷意義. 醫(yī)學(xué)臨床研究, 2004, 21(9): 89~90.
  50. 50. 邢晉玲. 兩種自身抗體檢測對系統(tǒng)性紅斑狼瘡診斷價值的探討. 四川省衛(wèi)生管理干部學(xué)院學(xué)報, 2004, 24(1): 112~113.
  51. 51. 袁玲玲, 盧憲梅, 趙天恩, 等. 系統(tǒng)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. 52. 蘇茵, 賈汝琳, 栗占國, 等. 自身抗體聯(lián)合檢測在系統(tǒng)性紅斑狼瘡診斷中的意義. 中華風(fēng)濕病學(xué)雜志, 2005, 9(1): 16~18.