抗中性粒细胞胞质抗体阳性表达在儿童狼疮肾炎中的临床价值研究

Clinical value of antineutrophil cytoplasmic antibody positive expression in children with lupus nephritis

目的探讨抗中性粒细胞胞质抗体(antineutrophilic cytoplasmic antibody,ANCA)阳性在狼疮肾炎(lupus nephritis,LN)患儿中疾病活动性以及对疾病严重程度的影响,为临床医生快速明确诊断,提供合理临床决策,规范诊治提供循证医学证据,为系统性红斑狼疮诊疗研究提供新的思路。方法收集2014年1月到2022年4月期间在昆明市儿童医院肾脏风湿免疫科及重症监护室接受住院治疗的LN患儿170例,其中完成ANCA检查的患儿共93例,ANCA阳性有33例,将其定为实验组,其余60例ANCA阴性患儿为对照组,将两组患儿的临床表现、实验室检查、SLEDAI评分、治疗及预后进行比较。结果LN患儿中最常见表现为蛋白尿(59.13%),其他常见表现依次为发热(48.38%)、水肿(39.78%)、血尿(34.4%);ANCA阳性患儿的肾功能损害程度明显高于ANCA阴性组患儿[ANCA阳性组肌酐(75.17±45.85)μmol/L;ANCA阴性组肌酐(55.63±41.78)μmol/L];ANCA阳性组24 h尿蛋白定量高于ANCA阴性组[(1.61±0.12)g比(1.02±0.38)g];ANCA阳性与ANCA阴性的LN患儿血常规、肝肾功能、血脂、免疫球蛋白、补体、炎症指标等差异无统计学意义;ANCA阳性组的患儿SLEDAI评分明显高于ANCA阴性组(SLEDAI评分平均数分别为15.62和11.78,P=0.033);ANCA阳性组生存率低于阴性组。结论ANCA阳性的LN患儿疾病活动性更强、基础肾功能更差、临床预后不良的可能性更大。

Objective To explore the activity of ANCA positive disease in children with lupus nephritis(LN)and examine its impact on the severity of disease to provide evidence-based rationales for rapid diagnosis,reasonable clinical decision-making and standardized management and offer new ideas for managing systemic lupus erythematosus(SLE).Methods From January 2014 to April 2022,retrospective review was conducted for the relevant clinical data of 170 hospitalized LN children.Experimental group had 93 children with ANCA testing and 33 were positive for ANCA.Clinical manifestations,laboratory tests,SLE Disease Activity Index(SLEDAI)score,treatments and prognoses of this group were compared with other 60 ANCA-negative children(control group).SPSS22.0 software was utilized for performing statistical analysis.Results The most common manifestations in LN children were proteinuria(59.13%),fever(48.38%),edema(39.78%)and hematuria(34.4%).The degree of renal damage was significantly greater in ANCA-positive group than that in ANCA-negative group.And 24-hour urinary protein quantity of ANCA positive group was higher than that of ANCA negative group.No significant differences existed between ANCA-positive and ANCA-negative SLE children in blood routine,liver/kidney function,lipids,immunoglobulins,complement or inflammatory parameters.SLEDAI scores were significantly higher in ANCA-positive group than those in ANCA-negative group(mean SLEDAI scores were 15.62 and 11.78,P=0.033).The survival rate of ANCA positive group was lower than that of ANCA negative group.Conclusions ANCA-positive LN children have greater disease activity,worse basic renal function and a higher probability of poor clinical prognosis.