抗DNA酶B抗体检测对急性链球菌感染后肾小球肾炎的临床诊断价值

The clinical diagnostic value of anti-deoxyribonuclease B for acute poststreptococcal glomerulonephritis

目的评价抗DNA酶B抗体(anti-deoxyribonuclease B,ADNase B)在急性链球菌感染后肾小球肾炎(acute poststreptococcal glomerulonephritis,APSGN)诊断中的临床应用价值。方法分别检测80例符合APSGN临床诊断患儿和50例近期无感染临床表现儿童的ADNase B、抗链球菌素O(anti-streptolysin O,ASO)滴度,同时记录APSGN患儿标本采集距前趋感染的时间及感染类型。68例APSGN患儿出院后,于前驱感染后2～6个月,再次取血检测ADNase B、ASO滴度。结果APSGN病例组ADNaseB阳性率(81.3%)显著高于ASO的阳性率(73.8%),P=0.008,二者联合检测阳性率达到90.0%。ADNase B ROC曲线下面积(0.90±0.04)显著大于ASO的曲线下面积(0.77±0.06),P=0.000。上感组及皮损组ADNase B阳性率(80.9%、83.3%)均高于ASO的阳性率(77.9%、50.0%),P<0.05。距前驱感染2～6个月时复查患儿ADNase B及ASO,二者阳性率均有下降,但ADNase B阳性率(73.5%)明显高于ASO的阳性率(42.6%),P<0.01。各组联合检测阳性率均较单独检测明显提高。结论ADNase B对于APSGN的诊断效能高于ASO,特别是对于前驱皮损感染及感染后2～6个月患儿的诊断优势更加明显,二者联合检测可明显提高阳性率。ADNaseB对A族链球菌(group A streptococcus,GAS)感染相关疾病的诊断具有较高的临床应用价值。

Objective To estimate the diagnostic value of anti-deoxyribonuclease B （ADNase B） in acute poststreptococcal glomerulonephritis （APSGN）. Methods The ADNase B and anti-streptolysin O （ASO） of 80 patients with APSGN and 50 children without any clinical manifestation of infection were measured separately. The time and type of GAS preceding infection were recorded simultaneously. The two antibodies of 68 patients with APSGN were measured repeadly during the second to the sixth month after the preceding infection. Results In patients with APSGN, the positive rate of ADNase B （81.3%） was significantly higher than that of ASO （73.8%,P=0.008）. And the combination of the two detections could increase the positive rate to 90.0% . The area under ROC curve of ADNase B （0.90±0.04） was significantly larger than that of ASO （0.77±0.06, P=0.000）. The positive rates of ADNase B （80.9% and 83.3%） were higher than that of ASO （77.9% and 50.0%） in upper respiratory tract infection and pyoderma subgroup respectiely. During the second to the sixth month after the preceding infection, the positive rates of the two antibodies were both descended. But the positive rate of ADNase B （73.5%） was obviously higher than that of ASO （42.6%）. In each subgroup, the combined measurement could increase the positive rate. Conclusions The diagnostic efficacy of ADNase B for APSGN is better than that of ASO. Particularly for patients with pyoderma infection and during the second to the sixth month after the preceding infection, the difference is significant. The combination of the two antibodies can increase the diagnostic positive rate. ADNase B is a valuable parameter for the diagnosis of poststreptococcal diseases.