抗心磷脂抗体检测肾病综合征患儿高凝倾向的临床意义

Clinical Meaning of Monitoring Serum Anti-cardiolipin Antibody in Nephrotic Syndrome Children with Hypercoagulability

目的 探讨血清抗心磷脂抗体 ( ACA)在肾病综合征 ( NS)高凝倾向中的变化及意义。方法 采用 ELISA法分别测定 2 0例肾病综合征患儿活动期 (治疗前 )及缓解期 (治疗后 )血清抗心磷脂抗体阳性者 ,并与 4 0例正常健康查体儿童作对照。在激素治疗的同时加用小剂量肝素钙 4～ 6周。结果 肾病综合征活动期 ACA阳性者明显高于对照组 ( P<0 .0 5) ,缓解期 ACA- Ig G,ACA- Ig M阳性率均降低 ,ACA- Ig M与治疗前相比差异有显著性 ( P<0 .0 5) ,而 ACA- Ig G较治疗前虽有下降 ,但无统计学意义。 2 0例患儿治疗 2～ 4周临床缓解或明显好转 ,无复发及并发症。结论 ACA可能参与 NS的免疫发病过程 ,与 NS的凝血系统改变、血栓形成密切相关 ,检测 ACA为 NS早期抗凝治疗提供客观的免疫学、病理学依据。小剂量肝素钙治疗 NS对病情转归、改善预后具有重要的临床意义。

Objective To investigate the change and its meaning of serum anti-cardiolipin antibody(ACA) in reflecting the inclination of hypercoagulability of nephrotic syndrome(NS).Method Before and after the treatment with corticoid plus small dose of heparin for 4～6 weeks,the serum ACA was measured by ELISA method in 20 nephrotic syndrome children and the results were compared with those obtained from 40 normal children.Result Before the treatment,the positive incidence of ACA in nephrotic syndrome group was higher than that of in control group(P<0.05).The positive incidence of ACA-IgG and ACA-IgM was decreased by the treatment.The difference was significant in ACA-IgM(P<0.05) and not significant in ACA-IgG.The clinical symptoms of all 20 NS children were relieved or cured by 2～4 weeks treatment.No any complications occurred.Conclusion ACA can be a pathogenetic factor and have intimate relation to the changes in blood coagulation function and thrombosis of NS children.The measurement of ACA can provide scientific basis of pathology and immunology for the early treatment of NS children.A small dose of heparin can be helpful to the relief of clinical symptoms in the treatment of NS children. [