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目的评价抗DNA酶B抗体(anti-deoxyribonuclease B,ADNase B)在急性链球菌感染后肾小球肾炎(acute poststreptococcal glomerulonephritis,APSGN)诊断中的临床应用价值。方法分别检测80例符合APSGN临床诊断患儿和50例近期无感染临床表现儿童的ADNase B、抗链球菌素O(anti-streptolysin O,ASO)滴度,同时记录APSGN患儿标本采集距前趋感染的时间及感染类型。68例APSGN患儿出院后,于前驱感染后2～6个月,再次取血检测ADNase B、ASO滴度。结果APSGN病例组ADNaseB阳性率(81.3%)显著高于ASO的阳性率(73.8%),P=0.008,二者联合检测阳性率达到90.0%。ADNase B ROC曲线下面积(0.90±0.04)显著大于ASO的曲线下面积(0.77±0.06),P=0.000。上感组及皮损组ADNase B阳性率(80.9%、83.3%)均高于ASO的阳性率(77.9%、50.0%),P<0.05。距前驱感染2～6个月时复查患儿ADNase B及ASO,二者阳性率均有下降,但ADNase B阳性率(73.5%)明显高于ASO的阳性率(42.6%),P<0.01。各组联合检测阳性率均较单独检测明显提高。结论ADNase B对于APSGN的诊断效能高于ASO,特别是对于前驱皮损感染及感染后2～6个月患儿的诊断优势更加明显,二者联合检测可明显提高阳性率。ADNaseB对A族链球菌(group A streptococcus,GAS)感染相关疾病的诊断具有较高的临床应用价值。
Objective To evaluate the clinical value of anti-deoxyribonuclease B (ADNase B) in the diagnosis of acute poststreptococcal glomerulonephritis (APSGN). Methods The ADNase B, anti-streptolysin O (ASO) titers of 80 cases of APSGN clinically diagnosed children and 50 cases of recent non-infected clinical manifestation children were detected respectively. At the same time, Infection time and type of infection. Sixty-eight patients with APSGN were discharged from hospital and 2 to 6 months after the precursor infection. Blood samples were taken again to measure ADNase B and ASO titers. Results The positive rate of ADNaseB in APSGN cases (81.3%) was significantly higher than that of ASO (73.8%), P = 0.008. The positive rate of ADNaseB was 90.0%. The area under the ROC curve of ADNase B (0.90 ± 0.04) was significantly greater than the area under the curve of ASO (0.77 ± 0.06), P = 0.000. The positive rates of ADNase B (80.9%, 83.3%) in the upper and lower skin lesions group were higher than those in the ASO group (77.9%, 50.0%, P <0.05). The positive rates of ADNase B and ASO were both lower in children with 2 ~ 6 months prior infection, but the positive rate of ADNase B (73.5%) was significantly higher than that of ASO (42.6%) (P <0.01). The positive rate of the combined detection in each group was significantly higher than that of the single detection. Conclusion The diagnostic efficacy of ADNase B for APSGN is higher than that of ASO. Especially for the diagnosis of pruritic lesions and 2 ~ 6 months after infection, the diagnostic value of ADNase B is more obvious. ADNaseB has a high clinical value in the diagnosis of diseases related to group A streptococcus (GAS) infection.