C reactive protein in the evaluation of febrile illness.

We studied prospectively 154 febrile children to determine the diagnostic value of the quantitative serum C reactive protein concentrations (CRP). Children with acute otitis media, acute tonsillitis, or treated with antibiotics during the two previous weeks and infants less than 2 months of age were excluded. Ninety seven children were from private paediatric practice and 57 were patients who had been admitted to hospital. The comparison group consisted of 75 children with confirmed bacterial infections whose CRP values were recorded retrospectively. In the study group 35 (23%) children had a confirmed viral infection, 92 (59%) had a probable viral infection as judged from the clinical picture and outcome of the illness, and 27 (18%) had a bacterial or probable bacterial infection. When the duration of the disease was more than 12 hours and the CRP value less than 20 mg/l, all children had a confirmed or probable viral infection. Nine children (one from the study group and eight from the comparison group) were found to have a septic infection and a CRP value of 20 mg/l or less. In all these cases, however, the duration of the symptoms was less than 12 hours. In addition CRP less than or equal to 20 mg/l was found in five (14%) children with urinary tract infection in the comparison group. CRP values of 20-40 mg/l were recorded in children with both viral and bacterial infections. A CRP value greater than or equal to 40 mg/l detected 79% of bacterial infections with 90% specificity. Our data show that determination of serum CRP concentrations is a valuable tool in evaluating children who have been ill for more than 12 hours.     

血清抗角蛋白抗体、抗核周因子和抗环瓜氨酸肽抗体在幼年类风湿关节炎应用中的评价

目的评价抗角蛋白抗体（AKA）、抗核周因子（APF）和抗环瓜氨酸肽抗体（anti-CCP）在幼年类风湿关节炎（JRA）应用中的意义。方法收集76例JRA及54例非JRA患儿,健康对照30例血清,测定其AKA、APF和抗CCP水平,对JRA诊断敏感性、特异性进行评价,并对JRA患儿中3种抗体阳性和阴性组的临床症状、体征及实验室检查指标进行比较,并作统计学分析。结果AKA、APF和抗CCP及联合检测ROC曲线下面积略高于0.5,但Pa〉0.05。单一抗体检测灵敏度为30%～50%,联合检测灵敏度无增加。单一抗体检测的特异度为50%～80%,联合检测特异度增加至80%～85%。JRA组AKA（＋）病例较多出现关节强直,心包积液,骨质稀疏,肺炎支原体抗体阳性率相对高,且ASO、ESR、CRP水平较高,Pa〈0.05;APF（＋）病例较多出现关节强直,骨质稀疏,肺炎支原体抗体阳性率相对高,而且ASO、ESR、CRP水平较高,有显著差异（P〈0.05）,抗CCP（＋）病例与抗CCP（-）病例比较,在临床表现、实验室检查方面无显著差异。结论AKA、APF、抗CCP抗体对JRA缺乏早期诊断意义及特异性,AKA、APF对判断疾病的活动性、病理损害程度和预后有临床意义。     

Serum C-reactive protein in early diagnosis of bacterial infections in premature infants

Serum C-reactive protein (CRP) is known to be produced by full-term infants and children in many diseases causing severe inflammation. We examined the usefulness of CRP as an early indicator of bacterial infection in premature newborn infants. CRP was obtained from 100 patients enrolled in a prospective study. All babies were suspected of having bacterial infection (meningitis-septicaemia) because of complications during pregnancy and/or symptoms suggestive of infection during the perinatal period. CRP was measured with the radial immunodiffusion technique. Examinations were done daily as long as elevated serum CRP levels were found. 100% (6/6) of our patients with culture-proven bacterial infections showed elevated CRP values within 24 h after the first clinical or laboratory signs suggesting sepsis. In 52.3% (11/21) of cases most probably suffering from infection, CRP rose within 72 h after the appearance of other symptoms. Even extremely immature infants were able to react with elevated CRP concentrations. Peak values of CRP were independent of birth weight. On the other hand, only 2.7% (2/73) of babies without findings of infection had slightly elevated amounts of CRP for a short time. Thus, serum CRP levels are a helpful parameter for the early diagnosis of severe bacterial infection in premature infants.     

Childhood Lyme arthritis: experience in an endemic area

We report 25 children with oligoarticular arthritis associated with Lyme disease. There were 16 boys (male/female ratio 1.8:1); ages ranged from 2 to 15 years. Thirteen (52%) children had no history of erythema chronicum migrans or other rash. Thirteen had temperatures as high as 41 degrees C for up to 2 months before the onset of arthritis. Twelve recalled definite tick bites. Ten (40%) children, of whom seven had no history of rash, were hospitalized for presumed septic arthritis. Another four had diagnoses of pauciarticular juvenile rheumatoid arthritis for as long as 3 years. Seven patients had less acute, recurrent episodes of synovitis. Two children had seventh nerve palsies 2 months before onset of arthritis. All patients had antibodies to the Lyme spirochete. In 14 patients, synovial fluid white blood cell counts ranged from 180 to 97,700/mm3 (greater than or equal to 76% polymorphonuclear leukocytes). Antibiotic therapy was effective in all patients; in 13, orally administered therapy alone resulted in elimination of synovitis and recurrent attacks. Lyme arthritis may be confused with acute bacterial septic arthritis or recurrent "pauciarticular juvenile rheumatoid arthritis," particularly when there is no history of erythema chronicum migrans.     

Negative C-reactive protein in children with bacterial infection*

PURPOSE: To evaluate the practical value of initial C-reactive protein (CRP) in the diagnosis of bacterial infection in children. METHODS: The subjects comprised 11 children, six boys and five girls, aged 3 months through to 3 years (median age 16 months), whose initial CRP levels were < 1.0 mg/dL despite bacterial infection. C-reactive protein was quantitated at the first medical examination by nephelometry. RESULTS: The diagnosis was urinary tract infection (n = 4), bacterial meningitis (n = 2), sepsis (n = 2), pneumonia (n = 2) and arthritis of the hip joint (n = 1). The CRP levels were significantly elevated during the course of infection, ranging from 7.6 to 28.5 mg/dL. The bacterial etiology was non-specific. Eight patients were examined within 12 h of onset, three exhibited negative CRP values despite the duration of the insult over 12 h. Six patients were tentatively diagnosed as having a bacterial infection, but the other five were not. Each patient was treated, leading to a favorable outcome without any serious complications. CONCLUSIONS: Low levels of CRP do not rule out the possibility of bacterial infection in children. The initial value of CRP may be negative, even in patients with severe bacterial infection or even after 12 h from onset. The data suggest that pediatricians should consistently be aware of the possibility of bacterial infection even if the initial CRP test result is negative and that serial CRP measurements appear to be practical.     

Diagnostic significance of increased serum hyaluronic acid in juvenile rheumatoid arthritis

BACKGROUND: We have previously reported that serum levels of hyaluronic acid (HA) objectively reflect the severity of arthritis in juvenile rheumatoid arthritis (JRA). However, clear diagnostic standards do not exist for JRA; it is difficult to evaluate arthritis in children, particularly in small children and the diagnostic criteria for JRA requires an exclusion of several diseases. Therefore, if a specific test finding associated with JRA could be established, it would enable general pediatricians to make an objective diagnosis. METHODS: We measured the serum HA levels in children with joint symptoms as a chief complaint. The total number of subjects were 197 children; of these 89 had JRA, 39 had rheumatic diseases other than JRA, and 69 had non-rheumatic diseases (including systemic 31, polyarticular 40 and pauci-articular in 17), rheumatic diseases other than JRA in 39 subjects, and non-rheumatic diseases in 69 subjects. Sandwich enzyme-linked immunosorbent assay measured HA by using the HA binding protein. RESULTS: The serum level of HA was significantly higher in systemic and polyarticular JRA patients than in patients with pauci-articular JRA, with rheumatic diseases other than JRA, and non-rheumatic patients. With a cut-off value of 100 ng/mL, a diagnostic value of HA in all JRA patients was 48.3% sensitivity and 98.1% specificity. CONCLUSIONS: In children presenting with joint symptoms, serum HA measurement is useful for diagnosing systemic and polyarticular JRA.     

Double blind, randomized, placebo-controlled study of dexamethasone therapy for hematogenous septic arthritis in children

BACKGROUND: Septic arthritis is associated with residual dysfunction in 10 to 25% of affected children. Concentrations of cytokines detected in synovial fluid of children with bacterial arthritis correlate with the severity of inflammation. Treatment with dexamethasone decreased cartilage degradation in experimental Haemophilus influenzae b and Staphylococcus aureus arthritis. ENDPOINTS: To decrease the number of patients with residual dysfunction of the affected joint at the end of therapy and at 6 and 12 months and to speed clinical recovery by the administration of dexamethasone. METHODS: In a double blind manner we randomly selected 123 children with suspected hematogenous bacterial arthritis to receive dexamethasone or saline for 4 days. Antibiotic therapy was tailored according to age and the recovered pathogen. RESULTS: Of the 123 children enrolled, 61 were assigned to the dexamethasone group and 62 to the placebo group. Only 50 and 50 patients in each group were evaluable. The 2 groups of patients were comparable with respect to age, sex, duration of symptoms, pathogen, affected joint and therapeutic and diagnostic procedures. Staphylococcus aureus accounted for 67% of the isolates, Haemophilus influenzae type b for 13% and Streptococcus pneumoniae for 9%. Dexamethasone therapy reduced residual dysfunction at the end of therapy, P = 0.000068; at 6 months, P = 0.00007; and at 12 months, P = 0.00053 of follow-up and shortened the duration of symptoms (P = 0.001) during the acute phase. The 26% incidence of residual dysfunction in the control patients was similar to the 25% found in other series. CONCLUSIONS: A short course of dexamethasone reduced residual joint dysfunction and shortened significantly the duration of symptoms in children with documented hematogenous septic arthritis. These results suggest that a 4-day course of low dose dexamethasone given early benefits children with hematogenous septic arthritis.     

The painful hip: evaluation of criteria for clinical decision-making

Children with a painful hip present a diagnostic challenge since clinical differentiation between septic arthritis, transient synovitis and Perthes disease may be difficult. Septic arthritis, a potentially life-threatening and debilitating medical emergency, requires early recognition for successful treatment, while transient synovitis and Perthes disease may be managed conservatively. An “ideal” single test for discrimination between these conditions is currently not available. We assessed the value of clinical examination and simple laboratory tests together with radiography and hip ultrasound in differentiating septic arthritis from transient synovitis and Perthes disease by analyzing the records of 89 children treated at our institution for hip pain. Ultrasound, radiographs, laboratory, clinical, and follow-up data were available for all the children. Diagnoses were made according to established criteria. Transient synovitis was present in 64 patients, septic arthritis in 8 (of whom 2 had additional osteomyelitis), and Perthes disease in 4. All children with septic arthritis had hip effusion shown by ultrasound and at least two of the following criteria: fever, elevation of erythrocyte sedimentation rate (ESR) and of C-reactive protein (CRP). None of the children without effusion on ultrasound or who lacked two or all criteria had septic arthritis. Radiographs had no significant impact on the decision-making in primary evaluation of acute hip pain. Conclusion We conclude that investigation of painful hips in children, based on hip ultrasound, body temperature, ESR and CRP, may allow cases for hip joint aspiration to be selected efficiently and may reduce the number of radiographs and hospital admissions. Received: 11 May 1999 / Accepted: 2 June 1999     

Chronic juvenile arthritis--difficult early diagnosis--differentiation of arthropathies in the patient case load of a juvenile arthritis hospital

Among 2369 children who had been admitted and treated in the Rheumatic Children's Hospital Garmisch-Partenkirchen between 1952 and 1979 under the diagnosis "juvenile chronic arthritis (JCA)" or, "collagenosis", there were 244 patients (= 10.3%) for whom in the end a different diagnosis was set. The major part of these children suffered from arthritides where there was proof of a direct or an indirect connection with bacterial infections or where there existed a corresponding suspected diagnosis (altogether 162 out of these 244 children, = 66.4%). The remaining 82 cases differentiated into 26 further diagnoses with various frequencies. Our examinations show that six criteria are found relatively frequently in arthropathies not caused by juvenile chronic arthritis. These require special consideration in the differential diagnosis: oligoarthritic onset of the disease, high fever - especially septic intermittent fever, erythema nodosum, endomyocarditis, no (or only very slight) functional resp. morphological changes of the joints.     

Cerebrospinal fluid C-reactive protein in the laboratory diagnosis of bacterial meningitis

Samples of cerebrospinal fluid from 112 cases of suspected meningitis were tested for the presence of C-reactive protein (CRP), using a qualitative and quantitative slide test. Bacterial meningitis was confirmed in 34 patients, based on CSF and blood culture results, and/or elevated CSF white blood cell (WBC) count and typical biochemical profile. There were 8 patients with early onset, and 3 who had received prior antimicrobial therapy among the 5 neonates, 23 children, and 6 adults with bacterial meningitis. Organisms recovered from CSF, and/or blood, included Haemophilus influenzae 14, Streptococcus pneumoniae 9, Streptococcus group B-5, Staphylococcus aureus 2, E. coli 2 and Klebsiella pneumoniae 1. Slide test was positive for CRP in 33 cases, giving a sensitivity of 97% which compared favourably with elevated CSF protein 33%, decreased CFS glucose 64.7% CSF glucose/blood glucose less than 1/2, 85%, raised CSF WBC 38.2%, raised CSF PMN 61.7%, CSF culture positive 88.2%, and CSF gram-positive 82.5%. Slide test was positive for CRP in 1 of 78 CSF samples negative for bacterial meningitis, giving a specificity of 98%. It was concluded that testing of CSF for CRP is a simple, rapid and accurate method for the laboratory diagnosis of bacterial meningitis, which is particularly appropriate for areas lacking adequate laboratory facilities.     

Detection of osteomyelitis and septic arthritis by nuclear magnetic resonance tomography in children

Suspected osteomyelitis or septic arthritis, respectively, is usually proven by means of clinical symptoms, laboratory data and microbiologic findings of blood cultures and joint fluids. In the early phase of the diseases conventional X-rays are not helpful. Imaging with isotopes is the most important procedure to describe localisation and extension of the inflammatory processes. Nuclear magnetic resonance imaging as a newer method is capable to detect these inflammatory processes very early, precisely and without discomfort for the patient. In four children with osteomyelitis and in one infant with septic arthritis, respectively, we were able to confirm the clinical diagnosis in a very early phase of the disease. In the patient with septic arthritis nuclear magnetic resonance was the only imaging procedure successfully localising the inflammatory process. Nuclear magnetic resonance imaging localises precisely inflammatory bone and joint diseases during the early stage of the disease.     

Cerebrospinal Fluid C-Reactive Protein in the Laboratory Diagnosis of Bacterial Meningitis

ABSTRACT. Samples of cerebrospinal fluid from 112 cases of suspected meningitis were tested for the presence of C-reactive protein (CRP), using a qualitative and quantitative slide test. Bacterial meningitis was confirmed in 34 patients, based on CSF and blood culture results, and/or elevated CSF white blood cell (WBC) count and typical biochemical profile. There were 8 patients with early onset, and 3 who had received prior antimicrobial therapy among the 5 neonates, 23 children, and 6 adults with bacterial meningitis. Organisms recovered from CSF, and/or blood, included Haemohilus influenzae 14, Streptococcus pneumoniae 9, Streptococcus group B 5, Staphylococcus aureus 2, E. coli 2 and Klebsiella penumoniae 1. Slide test was positive for CRP in 33 cases, giving a sensitivity of 97 % which compared favourably with elevated CSF protein 33 %, decreased CFS glucose 64.7 % CSF glucose/blood glucose 相似文献   

C-Reactive protein as a diagnostic tool of sepsis in very immature babies

Abstract Three hundred and nine septic screens were performed on 123 consecutively admitted infants of <30 weeks gestation. As part of the septic screen, serial quantitative measurements of C-reactive protein (CRP) were performed daily until discontinuation of antibiotic therapy. Complete blood counts were performed daily for the first 2 days of each septic episode.
The babies had a mean birth weight of 1035.8 g s.d. 273.2 and a mean gestational age of 27 weeks s.d. 1.8. A CRP level of 10 mg/L or above was considered abnormal. Subsequently the receiver operator characteristic curve for CRP was constructed to demonstrate the ideal cut off value.
Of the 309 septic screens, there were 51 instances of proven sepsis and 39 instances of deep culture negative sepsis. In the remaining 219, a diagnosis of proven or deep culture negative sepsis could not be made.
On the first day of the septic episode CRP showed a sensitivity of 62.7%, specificity of 87.2% and negative predictive value of 92.2% for proven sepsis. There was a significant increase in the sensitivity (90.2%) and negative predictive value (97.7%) of CRP with a specificity of 80.6 when both day 1 and 2 estimations were combined.
We conclude that when the CRP is elevated on day 1 and/or day 2, the diagnosis of sepsis is extremely likely and when the CRP is within normal limits on days 1 and 2 of the septic episode, neonatal sepsis can be confidently excluded and antibiotic therapy ceased.     

Acute septic arthritis in children

Background:  Acute septic arthritis is a health-care problem in growing children. The aim of the present study was to determine the demographic features, clinical presentation, diagnostic evaluation, treatment and outcome of children suffering from acute septic arthritis.
Methods:  Retrospective review of consecutive admissions of children ≤14 years of age with a bacteriologically and/or radiologically confirmed diagnosis of septic arthritis during the 10 year period, January 1997–December 2006 at King Fahad Hospital, King Abdulaziz Medical City was undertaken.
Results:  Sixty-five patients (male : female, 2.4:1), 10 days–14 years of age (mean ± SD: 3.3 ± 3.2 years), met the inclusion criteria. More than half of the patients were under 2 years. The most frequent clinical features were pain (92%), fever (77%), limitation of joint movement (77%) and joint swelling (72%). Joint involvement was monoarticular in 97% of knees, and hips were affected in 75% of patients. Bacteria were isolated from joint aspirate or blood in 28 patients (43%), and Staphylococcus aureus was the most common organism, comprising 39% of the total bacterial isolates. Radiological diagnostic findings were observed in 19 (32%) of 60 patients with plain radiographs, nine (69%) of 16 patients with sonograms of the hip, 36 (80%) of 45 patients with Tc-labeled bone scan and nine (100%) of nine patients with magnetic resonance imaging. The joint infection resolved with no sequelae in 46 patients who were followed up for 6–36 months, but two had bone deformity and 17 were lost to follow up.
Conclusion:  According to the present series, septic arthritis is most common in young infants, mainly monoarticular, and is frequently localized in the knee and hip joints. Early diagnosis and appropriate treatment are associated with excellent outcome.     

Reactive arthritis caused by Yersinia in children. Report of 4 cases

Among a group of children hospitalized for "joint pain", four of the cases of reactive arthritis were due to Yersinia infection. These four cases are described. Some patients had suggestive clinical symptoms but serologic studies were needed to establish the diagnosis. Tissue group studies showed that two children were HLA B27 and one was HLA B7. Reactive arthritis due to Yersinia in a form of "enteral arthritis". The prevalence of Yersinia arthritis has not been documented. Serologic tests are essential to outrule the main differential diagnosis, i.e. chronic juvenile arthritis (juvenile rheumatoid arthritis). Short-term resolution of symptoms is seen in every case. The long-term outcome is less well documented, especially with regard to the risk of recurrence and to relationships with peripheral joint disease and spondylarthropathies of early adulthood. HLA B27 positivity may be a risk factor. The pathogenesis of Yersinia-induced reactive arthritis is unclear; current studies are focusing on immunologic factors. The uncertainties concerning long-term outcome justifies renewed interest in childhood reactive arthritis.     

Septic arthritis in patients followed-up in neonatal intensive care unit

BACKGROUND: Septic arthritis is an uncommon, but serious disorder in neonates. Most patients survive with permanent handicaps. Due to the rarity of this condition in neonates and paucity of signs and symptoms, the diagnosis of septic arthritis in newborns is more difficult than in older children. METHODS: Septic arthritis or suppurative arthritis is an infection of the joint by a variety of microorganisms, including bacteria, viruses, mycobacteria and fungi. Purulent synovial fluid, positive culture and positive Gram stain were accepted as a gold standard for exact diagnosis. Fourteen neonates who were followed-up in a neonatal intensive care unit, with septic arthritis, were included in a study based on a review of medical reports and a long-term clinical and radiological follow-up. Clinical symptoms, bacteriology, risk factors and outcomes are discussed. RESULTS: Staphylococcus aureus was the predominant causative organism. Risk factors for septic arthritis were prematurity (4/14), umbilical catheterization or venous catheterization (3/14), sepsis (3/14), perinatal asphyxia (2/14) and difficult birth (1/14). All cases of septic arthritis in neonates were improved without squealae except in two patients. One patient died and one patient had severe squealae. In these two patients, the duration of disease from clinical onset to initiation of therapy was long. CONCLUSIONS: The most important prognostic factor in predicting a favorable outcome in neonatal septic arthritis is early diagnosis and therapy. When appropriate treatment is delayed, catastrophic sequelae are inevitable. Early diagnosis of the condition and rapid removal of pus are mandatory for the survival of the joint. Long-term follow-up may reveal effects of epiphyseal damage, early degenerative changes and limitation of the range of motion.     

幼年特发性关节炎肺胸膜病变的相关因素分析

目的 探讨幼年特发性关节炎（JIA）患儿肺胸膜病变（PLD）的高危因素,为临床判断病情、及时处理提供依据。方法 回顾分析360 例JIA 患儿的临床资料,所有患儿均行胸部X 线影像学检查,将患儿分为合并PLD 组和无PLD 组,分析JIA 伴肺胸膜病变（JIA-PLD）患儿的临床、影像学及相关实验室指标。结果 360 例JIA 患儿中,JIA-PLD 共43 例（11.9%）,其中有呼吸系统症状者9 例（21%）。胸部影像学异常主要表现为间质性肺炎（53.5%）,其次为胸膜炎和/或胸腔积液（38.1%）。43 例JIA-PLD 中胸片正常而胸部CT 异常者4 例（9.3%）。P结论 JIA-PLD 多发生于全身型JIA;PLD 好发于年龄<3 岁或≥ 12 岁者;伴有贫血、外周血WBC 及免疫球蛋白G 升高、类风湿因子或抗核抗体阳性者PLD 发生率高。PLD 影像学多表现为间质性肺炎,但由于患儿多缺乏呼吸系统表现,建议常规高分辨率胸部CT 检查以便临床早期发现、及时处理。     

The use of CRP for diagnosing infections in young infants < 3 months of age in developing countries

The diagnosis of severe bacterial infection in young infants in developing countries is difficult because of the lack of sensitivity and specificity of the presenting symptoms and signs. Whether C-reactive protein (CRP) might help with the early detection of neonatal sepsis was investigated in a prospective study in The Gambia, Ethiopia and The Philippines. Infants < 3 months of age with symptoms or signs of possible sepsis were evaluated; CRP was measured and assessed for its ability to predict proven invasive bacterial infection. Of 966 children < 3 months of age, 54 had a positive blood culture, 13 a positive CSF culture, 15 a positive blood and CSF culture and 884 had negative cultures. Median (interquartile range) CRP values were 42 (9-173), 14 (6-36), 209 (135-286) and 8 (3-27) mg/L in the four groups, respectively. Taking a CRP cut-off of 10 mg/L, the sensitivity and specificity of an elevated CRP to predict a positive blood or CSF culture were 77% and 55%, respectively, and 55% and 82%, respectively, for a cut-off of 40 mg/L. CRP lacks the sensitivity and specificity to be used alone as a predictor of serious infections in young infants.     

Atypical spondyloarthritis in children: proposed diagnostic criteria

Clinical and laboratory findings in 26 children with atypical spondyloarthritis were compared with those of 76 children with juvenile rheumatoid arthritis. The sensitivity, specificity, predictive value, and efficiency for diagnosis were calculated. The following findings (major criteria) were much more common in atypical spondyloarthritis than in juvenile rheumatoid arthritis: (1) spondyloarthritis within the family; (2) enthesopathy; (3) arthritis of digital joints; (4) sacro-iliitis; (5) presence of HLA-B27; (6) frequent recurrence of arthritis and arthalgia. Six additional findings (minor criteria) were significantly more common in atypical spondyloarthritis (SA): (1) disease onset after the age of 10 years; (2) male sex; (3) involvement of the lower extremities; (4) acute iridocyclitis or conjunctivitis; (5) arthritis of the hip joints; (6) manifestation following a history of enteritis. In the presence of 4 major criteria or 3 major and 3 minor criteria, the diagnosis of an atypical SA was established with a sensitivity of 84.6%, a specificity of 100%, and an efficiency of 96.1%.Abbreviations AS ankylosing spondylitis - JRA juvenile rheumatoid arthritis - RA rheumatoid arthritis - RF IgM-rheumatoid factor - RS Reiter syndrome - SA spondyloarthritis - SEA-Syndrome syndrome of seronegative enthesopathy and arthropathy     

儿童系统性红斑狼疮细胞膜DNA抗体间接免疫荧光检测研究

目的 间接免疫荧光法检测抗细胞膜DNA抗体(抗mDNA抗体),探讨抗mDNA抗体对儿童系统性红斑狼疮(SLE)的诊断价值.并与儿童SLE诊断的金指标抗dsDNA抗体和抗Sm抗体进行比较.方法 选取44例SLE患儿,30例非SLE自身免疫性疾病患儿作为对照组(包括幼年类风湿关节炎9例、幼年脊柱关节病13例、幼年皮肌炎4例、幼年干燥综合征2例、幼年血管炎2例).分别以早幼粒白血病细胞系HL60细胞和马疫锥虫为底物,用间接免疫荧光法检测抗mDNA抗体及抗dsDNA抗体;联合应用免疫双扩散法和免疫印迹法检测抗Sm抗体.结果 44例SLE患儿中34例抗mDNA抗体阳性,30例疾病对照组中抗mDNA抗体阳性者6例.抗mDNA抗体对儿童SLE诊断的敏感度和特异度分别为77.27%和80.00%,阳性预测值和阴性预测值分别为85.00%和70.59%.抗mDNA抗体、抗dsDNA抗体和抗Sm抗体对儿童SLE诊断的ROC曲线下面积分别为0.786、0.716和0.557,以抗mDNA抗体最高.在抗dsDNA抗体和抗Sm抗体阴性的儿童SLE患者中抗mDNA抗体的阳性率分别为68.00%(17/25)、79.49%(31/39).结论 抗mDNA抗体是一种诊断儿童SLE新的自身抗体,具有较高的敏感度和特异度,有助于抗dsDNA抗体和抗Sm抗体阴性的儿童SLE的诊断,检测方便,技术成熟,有一定的临床应用价值.