每日一题_2023.04.10

A 17-year-old girl complains of a painful, swollen left elbow and fever. In the previous few days her right knee was also swollen and slightly painful. The physician notices several oral ulcers and an edematous and tender left elbow. Laboratory tests are notable for weakly positive antinuclear antibodies and anemia, and the results of Venereal Disease Research Laboratory testing are positive. The patient is shocked when informed of her positive result for syphilis, stating that she has no sexual his- tory. Which of the following is the most specific antibody for the patient’s condition?

一名17岁女孩抱怨左肘部疼痛肿胀并发烧。在前几天，她的右膝盖也有肿胀和轻微疼痛。医生注意到几处口腔溃疡和左肘部水肿和压痛。实验室检测明显为弱阳性抗核抗体和贫血，性病研究实验室检测结果为阳性。当病人被告知她的梅毒阳性结果时，她震惊了，她说她没有性经验。下列哪一种抗体对患者的病情最特异?

(A) Anti-IgG

(B) Anti-Jo-1

(C) Anti-Smith

(D) Anticentromere

(E) Antimicrosomal

答案解析：

该患者患有系统性红斑狼疮(SLE)，其诊断依据是美国风湿病协会指定的11种症状中的4种，并由记忆法“BRAIN SOAP, MD”总结:血液出血不良(如溶血性贫血或血小板减少症)、肾脏疾病、关节炎(两个或两个以上外周关节)、免疫疾病(如抗dna抗体和抗史密斯抗体)、神经疾病、浆膜炎(如胸膜炎或心包炎)，口腔溃疡，抗核抗体(在无药物的情况下滴度升高，与药物性狼疮综合征相关)，光敏反应，颧疹和盘状疹。许多SLE患者有抗磷脂抗体，实际上被认为是针对磷脂复合物蛋白质的抗体。因为这些抗体也与梅毒血清学中使用的心磷脂抗原结合，SLE患者可能会出现梅毒假阳性结果。而抗核抗体对SLE敏感，抗史密斯和抗双链DNA是最特异性的。SLE中可能存在许多其他自身抗体，但这些抗体对SLE不一定敏感或特异性。

答案解析：C