全身型幼年特发性关节炎患儿自身抗体和炎性细胞因子研究

Autoantibodies and inflammatory cytokines in children with systemic-onset juvenile idiopathic arthritis

目的探讨自身抗体和炎性细胞因子在全身型幼年特发性关节炎(So-JIA)中的变化。方法分别采用间接免疫荧光法和酶联免疫吸附法检测活动期、缓解期So-JIA患儿血清抗角蛋白抗体(AKA)、抗环瓜氨酸肽抗体(抗CCP抗体)、白细胞介素-17(IL-17)和白细胞介素-6(IL-6)的表达水平。以健康儿童作为健康对照组进行比较。结果活动期组血清AKA、抗CCP抗体阳性率分别为29.4%、47.1%,缓解期组分别为17.2%、27.6%,活动期组均高于缓解期组(P<0.05)。So-JIA组AKA的灵敏度和特异度分别为21.1%和97.2%,抗CCP抗体的灵敏度和特异度分别为41.3%和91.9%,抗CCP抗体的灵敏度高于AKA。活动期组抗CCP抗体、IL-17、IL-6水平均高于健康对照组和缓解期组(P<0.05);缓解期组抗CCP抗体、IL-17、IL-6水平高于健康对照组,但比较差异无统计学意义(P>0.05)。结论自身抗体AKA和抗CCP抗体对So-JIA具有较高的特异度,但灵敏度欠佳,二者联合检测对提高So-JIA诊断特异度,尤其对提高活动期So-JIA诊断阳性率有一定的临床价值。

Objective To investigate the changes of autoantibodies and inflammatory cytokines in children with system‐onset ju‐venile idiopathic arthritis （So‐JIA） .Methods Serum concentrations of autoantibodies and inflammatory cytokines were measured in children with So‐JIA at active phase or remission phase by using indirect immunofluorescence method and enzyme‐linked immu‐nosorbent assay .Healthy children were enrolled as control group .Results The assay positivity of antikeratin antibody （AKA） and anti‐cyclic citrullinated peptide antibody （anti‐CCP） was 29 .4% and 47 .1% in active phase group ,and was 17 .2% and 27 .6% in remission group .The differences between the two groups were significant （P〈0 .05） .The diagnostic sensitivity of AKA and anti‐CCP was 21 .1% and 41 .3% ,and the diagnostic specificity was 97 .2% and 91 .9% .The diagnostic sensitivity of anti‐CCP was higher than AKA .Serum levels of anti‐CCP ,interleukin‐6 （IL‐6） and interleukin‐17 （IL‐17） of active phase group were higher than remission phase group and control group （P〈0 .05） ,and those of remission phase group were higher than control group ,but the differences were not significant （P〉0 .05） .Conclusion AKA and anti‐CCP might be with high diagnostic specificity to So‐JIA ,but the sensitivity could be low ,and combined detection could increase the diagnostic positivity .Inflammatory cytokines ,such as IL‐6 and IL‐17 ,might be associated with the activity of So‐JIA ,which could be important biomarkers of So‐JIA .