川崎病患儿血清抗内皮细胞抗体和抗中性粒细胞胞浆抗体检测的临床意义

Clinical significance of anti-neutrophil cytoplasmic antibodies and anti-endothelial cell antibodies in children with Kawasaki disease

目的探讨抗内皮细胞抗体(AECA)和抗中性粒细胞胞浆抗体(ANCA)在川崎病(KD)及其冠状动脉损害(CAL)中的临床意义。方法应用酶联免疫吸附试验定量检测42例KD患儿急性期、缓解期血清AECA和ANCA水平,并行心脏超声心动图了解CAL发生情况。随机选取20例因呼吸道感染发热患儿和15例外科择期手术患儿分别作为发热对照组和普通对照组。结果急性期KD组AECA、ANCA水平均显著高于两对照组(P<0.01)。与急性期相比,KD组缓解期血清ANCA水平下降(P<0.01),但仍高于发热对照组和普通对照组(P<0.05)。伴有CAL的KD患儿急性期血清ANCA水平明显高于无CAL患儿(P<0.01),且伴CAL患儿血清ANCA与左冠脉内径与主动脉瓣环内径比值呈正相关关系(r=0.88,P<0.01)。结论 AECA、ANCA可能参与了KD血管炎及其CAL的发生。急性期血清AECA、ANCA对早期难以确诊的KD有参考价值,ANCA水平异常增高对CAL有一定的预警价值。

Objective To study the clinical significance of anti-endothelial cell antibodies（AECA） and antineutrophil cytoplasmic antibodies（ANCA） in Kawasaki disease（KD） and its complication of coronary arterial lesions（CAL）. Methods Forty-two children with KD, as well as 20 children with fever caused by respiratory infection（fever control group） and 15 children for selective operation（normal control group）, were included in the study. Serum levels of AECA and ANCA were measured using enzyme-linked immunosorbent assay. Echocardiography was performed to evaluate CAL in KD patients. Results During the acute phase, the KD patients had significantly higher serum AECA and ANCA levels than the two control groups（P〈0.01）. The KD patients had reduced serum ANCA levels（P〈0.01） in the remission phase, but they were still higher than those of the two control groups（P〈0.05）. Among KD patients, those with CAL had significantly higher ANCA levels than those without CAL（P〈0.01） in the acute phase. There was a positive correlation between serum ANCA levels and the ratio of left coronary artery to aortic annular diameter in KD patients with CAL（r=0.88, P〈0.01）. Conclusions AECA and ANCA may be involved in vasculitis and CAL among children with KD. Serum levels of AECA and ANCA may be used as indicators for the diagnosis of suspected KD cases in the acute phase. Elevated ANCA level has a certain predictive value for CAL.