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目的探讨抗中性粒细胞胞浆抗体(ANCA)与小儿系统性红斑狼疮(SLE)活动性及狼疮性肾炎(LN)的相关性及临床意义。方法选择中国医科大学附属第一医院2009年6月至2012年9月初诊住院的≤18岁的SLE患儿共56例。收集患儿性别,发病年龄,临床症状包括皮肤血管炎、关节炎、发热、脱发、口腔溃疡、浆膜炎等临床资料,检测并记录患儿抗dsDNA抗体、抗核抗体(ANA)、抗Sm抗体、抗U1RNP抗体、抗SSA抗体、抗SSB抗体、补体C3、C4、血常规、尿系列、24h尿蛋白、尿微量蛋白等相关检验指标。其中25例尿蛋白异常的患儿完善肾组织活检。结果 (1)初诊SLE共56例患儿中ANCA阳性29例,全部为p-ANCA,阳性率为51.79%。所有患儿c-ANCA均为阴性。(2)ANCA阳性组和阴性组的临床表现、各项特异性自身抗体检测差异均无统计学意义(P>0.05),ANCA与初诊SLE患儿的疾病活动性指标相关性研究无统计学意义。(3)入选病例中,对25例尿蛋白异常的患儿进行了肾组织活检。其中ANCA阳性12例,ANCA阴性13例。结论 ANCA与初诊SLE及LN的病情无明显的相关性,故ANCA的检测对疾病活动性及肾脏受累程度的评估无统计学意义。
Objective To investigate the correlation between anti-neutrophil cytoplasmic antibody (ANCA) and systemic lupus erythematosus (SLE) activity and lupus nephritis (LN). Methods Fifty-six children with SLE ≤18 years old who were admitted to the First Affiliated Hospital of China Medical University from June 2009 to September 2012 were enrolled. The clinical data of the patients were collected, including clinical manifestations such as skin vasculitis, arthritis, fever, hair loss, oral ulcer, serositis and so on. The anti-dsDNA antibody, antinuclear antibody (ANA) Anti-U1RNP antibody, anti-SSA antibody, anti-SSB antibody, complement C3, C4, blood, urine series, 24h urine protein, urine micro-protein and other related test indicators. 25 cases of abnormal urinary protein in children with complete renal biopsy. Results (1) Of the 56 newly diagnosed SLE patients, 29 were ANCA positive, all of which were p-ANCA. The positive rate was 51.79%. All children with c-ANCA were negative. (2) The clinical manifestations of ANCA-positive group and negative group showed no significant difference in the detection of specific autoantibodies (P> 0.05). There was no statistically significant correlation between the ANCA and the newly diagnosed SLE children . (3) In the selected cases, 25 cases of abnormal urinary protein in children with renal biopsy. Among them, ANCA positive in 12 cases, ANCA negative in 13 cases. Conclusion There is no significant correlation between the ANCA and the newly diagnosed SLE and LN. Therefore, the ANCA test has no statistical significance on the disease activity and the degree of renal involvement.