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目的 探讨抗中性粒细胞胞浆抗体 (ANCA)与儿童风湿性疾病包括系统性红班狼疮 (SLE)、过敏性紫癜 (HSP)及混合性风湿性疾病 (MRD)肾损伤的关系。方法 采用间接免疫荧光法 (IIF)和酶联免疫吸附试验(ELISA)检测 10 5例患儿于疾病急性期血清ANCA ,检测并比较这些患儿肾损伤情况与ANCA的相关性。结果 血清ANCA阳性率为 :SLE 7/2 3(30 43 % )、HSP 15 /6 4(2 3 44 % )、MRD 6 /18(33 33 % ) ,其中核周型即P -ANCA 18例 (SLE 5例、HSP 9例、MRD 4例 ) ;胞浆型即C -ANCA 7例 (SLE 2例、HSP 4例、MRD 1例 ) ;未确定型即A -ANCA 3例 (HSP 2例、MRD 1例 )。比较患儿疾病急性期肾功能受损与血清ANCA水平的相关性 ,提示血清ANCA阳性患儿早期肾损伤率明显高于ANCA阴性患儿 (P <0 0 5 )。结论 本文提示ANCA可能对鉴别小儿风湿性疾病肾损伤具有重要意义 ,并可能成为该类疾病针对其肾损伤给予早期评价预后、选择积极治疗的重要免疫学血清指标
Objective To investigate the relationship between antineutrophil cytoplasmic antibody (ANCA) and childhood rheumatic diseases including systemic lupus erythematosus (SLE), Henoch-Schonlein purpura (HSP) and mixed renal rheumatic diseases (MRD). Methods Serum ANCA was detected in 105 children with acute phase of disease by indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assay (ELISA). The correlation between renal injury and ANCA in these children was detected and compared. Results The positive rates of ANCA in serum were as follows: SLE 7/2 3 (30 43%), HSP 15/64 (23 34%) and MRD 6/18 (33 33%), (5 cases of SLE, 9 cases of HSP and 4 cases of MRD), 7 cases of cytoplasmic C-ANCA (2 cases of SLE, 4 cases of HSP and 1 case of MRD), 3 cases of A-ANCA , MRD 1 case). Comparing the correlation between acute renal impairment and serum ANCA level in children with acute disease indicates that the rate of early renal injury in ANCA positive children is significantly higher than that in ANCA negative children (P <0.05). Conclusions This study suggests that ANCA may be of great importance for the identification of kidney damage in children with rheumatic diseases and may be an important immunological serological indicator for early diagnosis of renal disease