抗中性粒细胞胞浆抗体在儿童闭塞性细支气管炎病情评估中的价值

Value of anti-neutrophil cytoplasmic antibody in assessing the severity of bronchiolitis obliterans in children

目的探讨抗中性粒细胞胞浆抗体(ANCA)在儿童闭塞性细支气管炎(BO)病情评估中的临床价值。方法前瞻性选取2009年6月至2014年10月诊断为BO的患儿59例为研究对象,应用酶联免疫吸附法检测患儿血清中的髓过氧化物酶(MPO)及蛋白酶3(PR3)ANCA的浓度,根据其结果将患儿分为ANCA双阴性组(n=22)、ANCA单阳性组(n=17)及ANCA双阳性组(n=20)。比较入院时各组患儿的BO发生危险因素、临床症状、胸部高分辨CT(HRCT)及肺部病理学评分,以及ANCA表达水平及临床症状、胸部HRCT评分随时间的变化。结果ANCA双阳性组患儿的BO危险因素评分明显高于ANCA双阴性组(P<0.05),ANCA单阳性组及双阳性组的临床症状、胸部HRCT及肺部病理学评分均高于ANCA双阴性组(P<0.05)。患儿出院后随访6个月,MPO-ANCA、PR3-ANCA滴度水平均较入院时和出院时降低(P<0.05);其临床症状评分亦低于入院时(P<0.05),但胸部HRCT评分与入院时比较差异无统计学意义(P>0.05);ANCA单阳性组及双阳性组的临床症状评分仍高于ANCA双阴性组(P<0.05)。结论ANCA表达水平与BO患儿的病情严重程度具有相关性,对病情评估有一定的临床意义。

Objective To study the value of anti-neutrophil cytoplasmic antibody(ANCA)in assessing the severity of bronchiolitis obliterans(BO)in children.Methods A prospective analysis was performed on 59 children who were diagnosed with BO from June 2009 to October 2014.ELISA was used to measure the concentrations of myeloperoxidase(MPO)-ANCA and proteinase 3(PR3)-ANCA in serum.According to the results of ELISA,the children were divided into three groups:double-negative ANCA(n=22),single-positive ANCA(n=17),and double-positive ANCA(n=20).The three groups were compared in terms of the scores of BO risk factors,clinical symptoms,chest high-resolution computed tomography(HRCT),and lung pathology on admission,as well as the changes in the expression level of ANCA and the scores of clinical symptoms and chest HRCT over time.Results Compared with the double-negative ANCA group,the double-positive ANCA group had a significantly higher score of BO risk factors(P<0.05),and the single-positive ANCA group and the double-positive ANCA group had significantly higher scores of clinical symptoms,chest HRCT,and lung pathology(P<0.05).The children were followed up for 6 months after discharge,and there were significant reductions in MPO-ANCA and PR3-ANCA titers from admission and discharge to the end of follow-up(P<0.05),as well as a significant reduction in the score of clinical symptoms from admission to the end of follow-up(P<0.05),while there was no significant change in the score of chest HRCT from admission to the end of follow-up(P>0.05).The single-positive ANCA and double-positive ANCA groups still had a significantly higher score of clinical symptoms than the doublenegative ANCA group(P<0.05).Conclusions The expression level of ANCA is correlated with the severity of BO in children and thus has certain clinical significance in disease evaluation.