抗中性粒细胞胞浆抗体与儿童风湿性疾病

目的探讨抗中性粒细胞胞浆抗体(ANCA)与儿童风湿性疾病包括系统性红班狼疮(SLE)、过敏性紫癜(HSP)及混合性风湿性疾病(MRD)肾损伤的关系.方法采用间接免疫荧光法(IIF)和酶联免疫吸附试验(ELISA)检测105例患儿于疾病急性期血清ANCA,检测并比较这些患儿肾损伤情况与ANCA的相关性.结果血清ANCA阳性率为SLE7/23(30.43%)、HSP15/64(23.44%)、MRD6/18(33.33%),其中核周型即P-ANCA18例(SLE5例、HSP9例、MRD4例);胞浆型即C-ANCA7例(SLE2例、HSP4例、MRD1例);未确定型即A-ANCA3例(HSP2例、MRD1例).比较患儿疾病急性期肾功能受损与血清ANCA水平的相关性,提示血清ANCA阳性患儿早期肾损伤率明显高于ANCA阴性患儿(P<0.05).结论本文提示ANCA可能对鉴别小儿风湿性疾病肾损伤具有重要意义,并可能成为该类疾病针对其肾损伤给予早期评价预后、选择积极治疗的重要免疫学血清指标.

The relationship between ANCA and renal injury in children with rheumatic diseases

Objective To investigate the relationship between ANCA and renal damages in children with rheumatic diseases(RD).Methods Anti-neutrophil cytoplasmic antibodies(ANCA)and their specific antigens in 105 children with RD,including SLE,HSP,MRD were detected by IIF and ELISA.Results The results showed that percentage of total ANCA-positive was 28/105(26 67%).The percentage of ANCA-positive patients was 7/23(30 43%)in SLE,15/64(23 44%)in HSP,and 6/18(33 33%)in MRD respectively.Among 28 ANCA-positive ones,18 cases were P-ANCA,7 cases were C-ANCA,and 3 cases were A-ANCA.As compared with ANCA-negative patients,the renal damages ratios and levels of serum creatinine had incresaed significantly in ANCA-positive patients.Conclusion ANCA may be important in discerning the children with RD,and be an immunity target in appraising prognosis and selecting treatment.