间接免疫荧光法检测IgG型抗内皮细胞抗体在川崎病诊断中的意义

The clinical significanceof indirect immunofluorescence detection IgG anti-endothelial cell antibodies in the diagnosis of Kawasaki disease

目的探讨IgG型抗内皮细胞抗体(IgG-AECA)在川崎病诊断中的意义。方法采用间接免疫荧光法(IIF),以人脐静脉内皮细胞为底物抗原,分别检测2019年1—5月于南京医科大学附属儿童医院就诊的80例川崎病病儿急性期和恢复期外周血中IgG-AECA的表达情况,其中合并冠状动脉损伤(CAL)者29例。同时选取40例因呼吸道感染发热病儿和30例择期手术病儿作为一般发热组和正常对照组。结果急性期川崎病组IgG-AECA阳性率为41.2%(33/80),显著高于一般发热组[15.0%(6/40)]和正常对照组[0%(0/30)];与急性期相比,川崎病病儿恢复期IgG-AECA阳性率[20.0%(16/80)]下降,但仍高于一般发热组和正常对照组(P<0.05),伴有CAL的川崎病病儿急性期血清IgG-AECA阳性率为55.2%(16/29),明显高于无CAL病儿[29.0%(15/51)](P<0.05)。此外,IgG-AECA阳性川崎病病儿白细胞总数(WBC)、C反应蛋白(CRP)和血细胞沉降率(ESR)等炎性指标明显高于AECA阴性病儿(P<0.05),IgG-AECA高滴度组病儿外周血WBC、CRP和ESR高于低滴度组(P<0.05)。结论IgG-AECA在川崎病病儿特别是合并CAL病儿中有较高的阳性率,表明其参与了川崎病血管炎及CAL的发生,血清AECA的检测对川崎病早期诊断具有一定的参考价值。

Objective To evaluate the significance of IgG anti-endothelial cell antibody(IgG-AECA)for diagnosing Kawasaki dis⁃ease in children.Methods Using indirect immunofluorescence(IIF),human umbilical vein endothelial cells were used as the sub⁃strate antigen to detect the expression of IgG-AECA in peripheral blood during acute and recovery phases of 80 children with Kawasaki disease who were treated from Jan 2019 to May 2019 in Children's Hospital of Nanjing Medical University,including 29 children with coronary arterial lesions(CAL).As well as 40 children with fever caused by respiratory infection and 30 children for selective operation were were selected as general fever group and normal control group.Results The positive rate of IgG-AECA in KD patients during the acute phase was 41.2%(33/80),which was higher than those in normal fever group[15.0%(6/40)]and normal control group[0%(0/30)](P<0.05).The positive rate of IgG-AECA in KD patients was reduced in the recovery phase[20.0%(16/80)],which was also higher than those in normal fever group and normal control group(P<0.05).Among KD patients,those with CAL had higher frequency of IgG-AECA[55.2%(16/29)]than those without CAL[29.0%(15/51)](P<0.05).Besides,there was a significant difference in the results of WBC,CRP and ESR in IgG-AECA positive group compared with IgG-AECA negative group(P<0.05),as well as in different titration groups(P<0.05).Conclusions IgG-AECA has a higher positive rate in children with Kawasaki disease,especially children with CAL,indicating that it might be involved in vasculitis and CAL among children with KD.Serum levels of IgG-AECA may be used as an indicator for the diagnosis of suspected cases in the acute phase of KD,and elevated IgG-AECE level has a certain predictive value for CAL in KD pa⁃tients.