抗中性粒细胞胞浆抗体与儿童风湿性疾病肾脏损伤的关系

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

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 10 5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 :SLE 7/2 3(30 43 % )、HSP 15 /6 4(2 3 44 % )、MRD 6 /18(33 33 % ) ,其中核周型即P -ANCA 18例 (SLE 5例、HSP 9例、MRD 4例 ) ;胞浆型即C -ANCA 7例 (SLE 2例、HSP 4例、MRD 1例 ) ;未确定型即A -ANCA 3例 (HSP 2例、MRD 1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 0 5 )。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。

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.