rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2026-279-287rsp-3947Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHКлиническое значение антител к рибосомальному белку Р (а-Rib-P) у больных системной красной волчанкой и антифосфолипидным синдромомThe clinical significance of antibodies to ribosomal protein P (a-Rib-P) in patients with systemic lupus erythematosus and antiphospholipid syndromehttps://orcid.org/0000-0001-9437-406XЛисицынаТ. А.LisitsynaT. A.

Лисицына Татьяна Андреевна

115522, Каширское шоссе, 34а

Tatiana Lisitsyna

115522, Moscow, Kashirskoye Highway, 34A

talisitsyna@rambler.ruhttps://orcid.org/0000-0003-3552-2522РешетнякТ. М.ReshetnyakT. M.

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

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

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

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

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

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

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

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

115522, Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

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

115522, Москва, Каширское шоссе, 34а; 117997, Москва, ул. Островитянова, 1

115522, Moscow, Kashirskoye Highway, 34A; 117997, Moscow, Ostrovitianova str., 1

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 Federation202630062026643279287Copyright © Лисицына Т.А., Решетняк Т.М., Диатроптов М.Е., Авдеева А.С., Нурбаева К.С., Абрамкин А.А., Насонов Е.Л., 20262026Лисицына Т.А., Решетняк Т.М., Диатроптов М.Е., Авдеева А.С., Нурбаева К.С., Абрамкин А.А., Насонов Е.Л.Lisitsyna T.A., Reshetnyak T.M., Diatroptov M.E., Avdeeva A.S., Nurbaeva K.S., Abramkin A.A., Nasonov E.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/3947

Цель исследования – определить клиническое значение антител к рибосомальному белку Р (a-Rib-P, antibodies to ribosomal-P protein) у больных системной красной волчанкой (СКВ) и антифосфолипидным синдромом (АФС).

Материал и методы

Материал и методы. В исследование включены 68 пациентов с достоверными диагнозами СКВ и АФС (СКВ – 25, СКВ+АФС – 19, первичный АФС (ПАФС) – 24). Преобладали женщины (72,1%) молодого возраста (в среднем 35,1±10,2 года). Все пациенты обследованы по стандартам, рекомендованным Ассоциацией ревматологов России, а также осмотрены врачом-психиатром. У всех пациентов и 20 здоровых доноров, подобранных по полу и возрасту, методом иммуноферментного анализа в сыворотке крови были определены a-Rib-P.

Результаты

Результаты. Концентрация а-Rib-P у пациентов статистически значимо выше, чем у здоровых доноров (медиана 0,004 [0,003; 0,015] против 0,002 [0,002; 0,003] Ед/мл соответственно; р=0,002). Повышенный уровень a-Rib-P отмечался у 6 (13,6%) из 44 пациентов с СКВ, но не выявлен при ПАФС и у здоровых доноров. У пациентов с текущими неврологическими проявлениями, включая острое нарушение мозгового кровообращения/преходящее нарушение мозгового кровообращения, судорожный синдром (эпилепсия, гиперкинезы), уровень а-Rib-P был статистически значимо выше, чем при их отсутствии (медиана 0,004 [0,003; 0,021] против 0,002 [0,002; 0,003] Ед/мл соответственно; р=0,001). Концентрация а-Rib-P статистически значимо выше у пациентов с СКВ, имеющих повышенный уровень антител к двуспиральной ДНК/ антител к Smith-антигену (а-Sm), по сравнению с теми, у кого содержание этих аутоантител оставалось в норме (медиана 0,005 [0,004; 0,106] против 0,004 [0,002; 1,35] соответственно; p=0,007 и 2,41 [0,058; 10,3] против 0,005 [0,002; 0,012] Ед/мл соответственно; p=0,001). Пациенты с гиперпродукцией a-Rib-P имели статистически значимо более высокую вероятность поражения кожи (отношение шансов (ОШ) – 17,0; p < 0,001) и статистически не значимо более высокую частоту поражения слизистых (ОШ=9,0), центральной нервной системы (ОШ=1,32), полиартрита (ОШ=3,75), гематологических нарушений (ОШ=3,75), высокой активности СКВ по индексу SLEDAI-2K (Systemic Lupus Erythematosus Disease Activity Index 2000) (ОШ=4,33), биполярного аффективного расстройства (ОШ=4,25), большого депрессивного расстройства (ОШ=1,4), повышенной концентрации а-Sm (ОШ=5,0), антител к кардиолипину/β2-гликопротеину 1 (ОШ=2,61), к комплексу фосфатидилсерин/протромбин (ОШ=2,33) и к NR2-субъединице глутаматных N-метил-Dаспартат рецепторов (ОШ=2,2), а также высокого риска тромбозов по GAPSS (Global AntiphosPholipid Syndrome Score) (ОШ=3,77).

Заключение

Заключение. а-Rib-P являются высокоспецифичными для больных СКВ и не характерны для пациентов с ПАФС, ассоциируются с различными клинико-лабораторными проявлениями высокой активности СКВ, в первую очередь кожно-слизистыми, неврологическими и иммунологическими.

The aim – to determine the clinical significance of hyperproduction of antibodies to ribosomal protein P (a-Rib-P) in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS).

Material and methods

Material and methods. The study included 68 patients with reliable diagnoses of SLE and APS (SLE – 25, SLE+APS – 19, primary APS (PAPS) – 24). Young (35,1±10,2 years) women prevailed (72,1%). All patients were examined according to the standards recommended by the Association of Rheumatologists of Russia, and also examined by a psychiatrist. a-Rib-P 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 a-Rib-P in patients was significantly higher than in healthy donors (0.004 [0.003; 0.015] vs 0.002 [0.002; 0.003] U/ml, respectively; p=0.002). Elevated a-Rib-P values were detected in 6 (13.6%) out of 44 patients with SLE, but were not detected in PAPS and in healthy donors. In patients with current neurological disorders (stroke/epilepsy/hyperkinesis), the concentration of a-Rib-P is statistically significantly higher than in their absence (0.004 [0.003; 0.021] vs 0.002 [0.002; 0.003] U/ml, respectively; p=0.001). The concentration of a-Rib-P is significantly higher in patients with SLE and elevated values of antibodies to double stranded DNA/anti-Smith antibodies (a-Sm), compared with those with normal values of these autoantibodies (0.005 [0.004; 0.106] vs 0.004 [0.002; 1.35], respectively; p=0.007 and 2.41 [0.058; 10.3] vs 0.005 [0.002; 0.012] U/ml, respectively; p=0.001). Patients with an increased a-Rib-P value had a significantly higher chance of skin (odds ratio (OR) – 17.0; p<0.001) lesions and a statistically insignificant – mucous lesions (OR=9.0), central nervous system lesion (OR=1.32), polyarthritis (OR=3.75), hematological imparements (OR=3.75), high SLE activity according to the SLEDAI-2K (Systemic Lupus Erythematosus Disease Activity Index 2000) (OR=4.33), bipolar affective disorder (OR=4.25), major depressive disorder (OR=1.4), elevated concentrations of a-Sm (OR=5.0), anti-cardiolipin/anti-β2 glycoprotein 1 antibodies (OR=2.61), anti-phosphatidylserine/prothrombin antibodies (OR=2.33) and anti-N-methyl-D-aspartate receptor antibodies (OR=2.2), as well as a high risk of thrombosis according to GAPSS (Global AntiphosPholipid Syndrome Score) (OR=3.77).

Conclusion

Conclusion. a-Rib-P are highly specific for patients with SLE and aren’t typical for patients with PAPS. They are associated with various clinical and laboratory manifestations of high SLE activity, primarily skin-mucosal, neurological, and immunological.

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