1、Clinical Significance Of Anti SmD1_83-119Antibody In Systemic Lupus Erythematosus Based On CSTAR Cohort Data 2、Clinical Characteristics Of Systemic Lupus Erythematosus Associated Refractory Thrombocytopenia

Objective:To investigate the diagnostic value and correlation with clinical feature of anti-SmD1_83-119 antibody in patients with Systemic Lupus Erythematosus（SLE）based on CSTAR cohort data in order to determine the clinical significance of anti-SmD1_83-119 zantibody in SLEMethods:A total of 609 subjects were divided into SLE group（n=266）.disease control group（n=233）and normal control group（n=110）.Serum samples were collected separately.ELISA technique was used to detect anti-Sm antibody、anti-SmD1_83-119 antibody and anti-dsDNA antibody in each sample.（1）Sensitivity、specificity、positive predictive value、negative predictive value、Youden index and the receiver operating characteristic curve（ROC）of anti-SmDl83-119 antibody were analyzed.（2）The correlation between anti-SmDl83-119 antibody and SLEDAI、SDI score in SLE group,the difference of disease activity and organ damage between anti-SmDl83-119 antibody positive and negative SLE patients,and the difference of positive rate of anti-SmDl83-119 antibody between initial treatment and non-initial treatment SLE patients were compared respectively.Results:（1）The sensitivity（60.90%）of anti-SmDl83-119 antibody in SLE group was lower than anti-Sm antibody and anti-dsDNA antibody,but the specificity（88.05%）and Youden index（0.4895）were higher.The sensitivity of combined detection of anti-SmDl83-119 antibody with anti-Sm antibody and/or anti-dsDNA antibody was reduced to 19.17%～38.72%,while the specificity was 100%.The sensitivity of anti-SmDl83-119 antibody in diagnosis of SLE with anti-Sm antibody and/or anti-dsDNA antibody negative was 36.45%～88.46%,and the specificity was 89.15%～89.42%.The area under the ROC curve of anti-SmDl83-119 antibody was 0.873.The optimal diagnostic value of anti-SmDl83-119 antibody was 38.43 U/ml of which sensitivity was 53%。and specificity was 92.1%.（2）The anti-SmDl83-119 antibody positive rate in 266 SLE patients had no significant correlation with SLEDAI score（P>0.05）,also not with SDI（P>0.05）.There was no significant difference in SLEDAl score between anti-SmDl83-119 antibody positive（n=162）and negative（n=104）SLE patients（10.44±9.00 vs 9.50±8.00,P>0.05）.When compared with anti-SmDl83-119 antibody negative SLE patients,the incidence of rash[77/162（47.53%）vs 18/104（17.31%）,P<0.05]、alopecia[63/162（38.89%）vs 19/104（18.27%）,P<0.05]、low complement[107/162（66.05%）vs 52/104（50.00%）,P<0.05]and elevated anti-dsDNA antibody[92/162（56.79%）vs 44/104（42.31%）,P<0.05]was higher,while the incidence of psychosis[1/162（0.62%）vs 6/104（5.77%）,<0.05]was lower.There was no significant difference between SmD1_83-119 positive and negative SLE patients with SDI score（P>0.05）.The positive rate of anti SmD1_83-119 antibody in patients with initial treatment（n = 97）and non-initial treatment（n= 169）SLE was not statistically significant（P>0.05）.Conclusions:（1）The specificity（88.05%）of anti-SmDl83-119 antibody in the diagnosis of SLE was lower,while the sensitivity（60.90%）and diagnostic efficiency were higher when compared with anti-Sm antibody and anti-dsDNA antibody.The sensitivity of anti-SmD1_83-119 antibody、anti-Sm antibody and anti-dsDNA antibody by combination of two or three was reduced,while specificity was high.Anti-SmD1_83-119 antibody has high specificity for the diagnosis of SLE with anti-Sm antibody and/or anti-dsDNA antibody negative.（2）The positive rate of anti-SmD1_83-119 antibody had no correlation with SLE disease activity and irreversible organ injury.The incidence of rash.alopecia.low complement and elevated anti-dsDNA antibody in SLE patients with anti-SmD1_83-119 antibody positive was higher than that in negative SLE,while the incidence of psychosis was lower.Anti-SmD1_83-119 antibody positive could not predicte SLE recurrence.Objective:A retrospective review of systemic lupus erythematosus associated refractory thrombocytopenia（SLE-RTCP）was performed to explore its clinical characteristics.Methods:35 SLE-RTCP patients were identified in Peking Union Medical College Hospital of Beijing China from January 1998 to December 2013,and patients were classified as isolated thrombocytopenia type（n=14）and multisystem involved type（n=21）according to the clinical features when thrombocytopenia first appeared,whose clinical characteristics were compared between two types.Results:Two types were both of female predominance and young flare-up with chronic disease course（P>0.05）.Mucocutaneous hemorrhage and hypermenorrhea,as well as bone marrow abnormality were identical in two types（P>0.05）.But compared with multisystem involved type,isolated thrombocytopenia type presented higher proportion of thrombocytopenia predated SLE diagnosed（64.3%versus 14.3%,p=0.002）.Isolated thrombocytopenia type less likely to present serositis（7.1%versus 38.1%,p=0.040）,arthritis,nervous system disturbance（14.3%versus 66.7%,p=0.002）and positive anti-dsDNA antibody（42.9%versus 76.2%,p=0.046）according to 1997 ACR criteria,but more likely exhibited musculoskeletal damage（14.3%versus 71.4%,p=0.001）in cumulative organ involvement compared with multisystem involved type.At early stage SLEDAI[5（3-12）versus 1（1-5）,p=0.007]and SDI[1（1-1.5）versus 0（0-1）,p=0.031]were higher in multisystem involved type,but at late stage most of patients in each type presented persistently severe thrombocytopenia with low disease activity and bleeding manifestations（P>0.05）.Conclusion:SLE-RT.CP could be classified as isolated thrombocytopenia and multisystem involved types at early stage,but most of patients in each type presented persistently severe thrombocytopenia with low disease activity and bleeding manifestations at late stage.