抗心磷脂抗体与儿童过敏性紫癜关系的探讨

Discussion of the relation between anti-cardiolipin antibodies and Henoch-Sch¨onlein purpura in children

目的探讨抗心磷脂抗体(anticardiolipin,ACA)与儿童过敏性紫癜(Henoch-sch¨onlein purpura,HSP)的关系。方法采用酶联免疫吸附试验(ELISA)对91例急性期HSP患儿(HSP组)和30例健康体检儿童(对照组)的血清进行IgG型ACA(IgG-ACA)和IgM型ACA(IgM-ACA)检测,并对两组ACA阳性率进行统计学比较。结果 91例HSP患儿中有16例ACA阳性,其中IgM-ACA阳性13例,IgG-ACA阳性3例,总阳性率占17.6%,且均无抗磷脂综合征(APS)表现;而健康体检儿未检出ACA阳性者。经Fisher精确概率检验,差异有显著性(χ2=6.078,P<0.05)。HSP组中50例伴有腹痛的患儿中其13例ACA阳性,阳性率为26.0%;而41例不伴腹痛的患儿中仅3例ACA阳性,阳性率为7.3%,经χ2检验,差异有显著性(χ2=5.426,P<0.05)。26例肾脏受损者中ACA阳性4例;65例无肾脏受损者中ACA阳性12例,经χ2检验,差异无显著性(χ2=0.002,P>0.05)。结论 ACA可能与儿童HSP发病及腹痛症状有关、与HSP肾损害无关;APS可能与儿童HSP无关。

Objective To discuss the relation between anti-cardiolipin antibodies （ACA） and Henoch-Schonlein purpura（HSP） in children. Methods The levels of serum IgG-ACA and IgM-ACA in 91 children with Henoch Schonlein purpura in acute stage （HSP group） and 30 healthy cases （control group） were tested with enzyme-linked immunosorbent assay （ELISA）. Statistical analysis were performed to compare the differences of serum ACA levels between two groups. Results 16 patients in HSP group were positive of serum levels of ACA, with 13 of IgM-ACA and 3 of IgG-ACA respectively, and no one manifested signs of antiphospholipid syndrome. None of healthy cases in control group were positive of ACA, the overall positive rate of ACA in HSP group was 17.6% and statistically different （Fisher exact probability test,x2 = 6. 078, P 〈 0.05）. In HSP group, 13 cases out of 50 patients with abdominal pain were positive of ACA and the positive rate was 26.0% ; only 3 cases among 41 patients without abdominal pain were positive of ACA and the positive rate was 7. 3%. The difference was statistically significant （χ2 = 5. 426, P 〈 0.05 ）. 4 cases out of 26 patients of Henoeh-Schonlein purpura with renal damage were positive of ACA. Among 65 patients without renal damage, 12 eases were positive of ACA and the difference was not statistically significant （χ2 = 0. 002, P 〉 0.05）. Conclusions Serum ACA may have a connection with pathogenesis of childhood HSP and abdominal pain, but not correlate with renal damage. Antiphospholipid syndrome probably has nothing to do with childhood HSP.