rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2025-168-175rsp-3726Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHКлиническое значение антител к NR2-субъединице глу таматных Nметил-D-аспартат-рецепторов (аNMDAR) у больных системной красной волчанкой и антифосфолипидным синдромомClinical significance of the determination of antibodies to the NR2 subunit of glutamate N-methyl-D-aspartate receptors (aNMDAR) in patients with systemic lupus erythematosus and antiphospholipid syndromehttps://orcid.org/0000-0001-9437-406XЛисицынаТ. А.LisitsynaT. A.

Лисицына Татьяна Андреевна

115522, Москва, Каширское шоссе, 34

Tatiana A. Lisitsyna

115522, Moscow, Kashirskoye Highway, 34A

talisitsyna@rambler.ruhttps://orcid.org/0000-0001-6802-0268БорисоваА. Б.BorisovaA. B.

115522, Москва, Каширское шоссе, 34

Anastasia B. Borisova

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0003-3552-2522РешетнякТ. М.ReshetnyakT. M.

115522, Москва, Каширское шоссе, 34

Tatiana M. Reshetnyak

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-5210-2605ВельтищевД. Ю.VeltishchevD. Yu.

115522, Москва, Каширское шоссе, 34а,

117997, Москва, ул. Островитянова, 1

Dmitry Yu. Veltishchev

115522, Moscow, Kashirskoye Highway, 34A,

117997, Moscow, Ostrovitianova str., 1

https://orcid.org/0000-0001-6404-0042ДиатроптовМ. Е.DiatroptovM. E.

115522, Москва, Каширское шоссе, 34

Mikhail E. Diatroptov

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0003-3057-9175АвдееваА. С.AvdeevaA. S.

115522, Москва, Каширское шоссе, 34

Anastasia S. Avdeeva

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0001-6685-7670НурбаеваК. С.NurbaevaK. S.

115522, Москва, Каширское шоссе, 34

Kamila S. Nurbaeva

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-1504-5645АбрамкинА. А.AbramkinA. A.

115522, Москва, Каширское шоссе, 34

Anton A. Abramkin

115522, Moscow, Kashirskoye Highway, 34A

https://orcid.org/0000-0002-1598-8360НасоновЕ. Л.NasonovE. L.

115522, Москва, Каширское шоссе, 34

Evgeny L. Nasonov

115522, Moscow, Kashirskoye Highway, 34A

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»; ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияV.A. Nasonova Research Institute of Rheumatology; N.I. Pirogov Russian National Research Medical UniversityRussian Federation202501052025632168175Copyright © Лисицына Т.А., Борисова А.Б., Решетняк Т.М., Вельтищев Д.Ю., Диатроптов М.Е., Авдеева А.С., Нурбаева К.С., Абрамкин А.А., Насонов Е.Л., 20252025Лисицына Т.А., Борисова А.Б., Решетняк Т.М., Вельтищев Д.Ю., Диатроптов М.Е., Авдеева А.С., Нурбаева К.С., Абрамкин А.А., Насонов Е.Л.Lisitsyna T.A., Borisova A.B., Reshetnyak T.M., Veltishchev D.Y., Diatroptov M.E., Avdeeva A.S., Nurbaeva K.S., Abramkin A.A., Nasonov E.L.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/3726

Цель исследования – определить клиническое значение гиперпродукции антител к NR2-субъединице глутаматных N-метил-D-аспартат-рецепторов (аNMDAR, anti-N-methyl-D-aspartate receptors) у больных системной красной волчанкой (СКВ) и антифосфолипидным синдромом (АФС).

Материал и методы

Материал и методы. В исследование включены 66 пациентов с достоверными диагнозами СКВ и АФС (СКВ – 24 пациента; СКВ+АФС – 18 пациентов; первичный АФС – 24 пациента). Преобладали женщины (72,7%) молодого возраста (в среднем 35,5±10,2 года). Все пациенты обследованы по стандартам, рекомендованным Ассоциацией ревматологов России, а также осмотрены психиатром. У 62 (93,9%) из них выявлены нейропсихиатрические синдромы, преимущественно психиатрические. У всех пациентов и 20 здоровых доноров, подобранных по полу и возрасту, методом иммуноферментного анализа в сыворотке крови определялось содержание aNMDAR.

Результаты

Результаты. Концентрация aNMDAR у пациентов с неврологическими проявлениями СКВ и АФС была статистически значимо выше, чем у здоровых доноров (в среднем 4,32±2,0 и 2,96±1,44 нг/мл соответственно; р=0,042). У пациентов с повышенной концентрацией aNMDAR была статистически значимо выше (р<0,05) вероятность выявления таких неврологических проявлений, как острое нарушение мозгового кровообращения, преходящее нарушение мозгового кровообращения, эпилепсия (отношение шансов (ОШ) – 9,0), а также биполярного аффективного расстройства (ОШ=14,0), и статистически не значимо выше – шизотипического расстройства (ОШ=3,8) и умеренных когнитивных нарушений по органическому типу (ОШ=2,15). Вероятность выявления АФС у больных с повышенным уровнем aNMDAR была выше в 1,7 раза, высокого риска тромбоза по индексу GAPSS (Global Anti-Phospholipid Syndrome Score) – в 4,28 раза, позитивности по антифосфолипидным антителам (к кардиолипину, β2-гликопротеину 1, комплексу фосфатидилсерин/протромбин) и антителам к двуспиральнеой ДНК – в 2,5–6,73 раза (различия статистически не значимы).

Заключение

Заключение. аNMDAR могут играть важную роль в развитии определенных нейропсихиатрических проявлений у больных СКВ и АФС. Целесообразно проведение более масштабных исследований, направленных на подтверждение необходимости определения аNMDAR в качестве биомаркера для диагностики и мониторинга прогрессирования нейропсихиатрических проявлений СКВ и АФС.

The aim – to determine the clinical significance of hyperproduction of antibodies to the NR2 subunit of glutamate N-methyl-D-aspartate receptors (aNMDAR) in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS).

Material and methods

Material and methods. The study included 66 patients with reliable diagnoses of SLE and APS (SLE – 24 patients; SLE+APS – 18 patients, primary APS – 24 patients). Young women (35.5±10.2 years) prevailed (72.7%). All patients were examined according to the standards recommended by the Association of Rheumatologists of Russia, and also examined by a psychiatrist. Neuropsychiatric syndromes, mainly psychiatric, were detected in 62 (93.9%) patients. aNMDAR was determined in all patients and 20 healthy donors, matched by gender and age, by enzyme immunoassay in blood serum.

Results

Results. The concentration of aNMDAR in patients with neurological manifestations of SLE and APS did not exceed the threshold value, but was significantly higher than in healthy donors (4.32±2.0 versus 2.96±1.44 ng/ml, respectively; p=0.042). Patients with elevated aNMDAR concentrations had a statistically significantly higher (p<0.05) probability of detecting neurological manifestations such as acute/transient cerebrovascular accident/epilepsy (odds ratio (OR) – 9.0), as well as bipolar affective disorder (OR=14.0), and statistically not significantly – schizotypal disorder (OR=3.8) and moderate cognitive impairment (organic type) (OR=2.15). The probability of detecting APS in patients with elevated aNMDAR values was 1.7 times higher, the risk of thrombosis according to the GAPSS (Global Anti-Phospholipid Syndrome Score) was 4.28 times higher, and aPL positivity (aCL, aß2GP-1, aFs/Pt) and a-ds-DNA – 2.5–6.73 times (the differences were not statistically significant).

Conclusion

Conclusion. aNMDAR may play an important role in the development of certain neuropsychiatric manifestations in patients with SLE and APS. It is advisable to conduct larger-scale studies aimed at confirming the need to identify aNMDAR as a biomarker for the diagnosis and monitoring of the progression of neuropsychiatric manifestations of SLE and APS.

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The authors declare that there are no conflicts of interest present.