过敏性紫癜患儿血清中IgA1半乳糖基的缺失水平及临床意义  

The serum levels of galactose-deficient IgA1 in children with Henoch-Schnlein purpura and its clinical significance

作　　者：袁芳[1] 胡筱[1] 王飞飞[2] 刘兰波[2] 殷蕾[1] 莫茜[2] 金燕樑[1,2] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心风湿科,上海200127 [2]上海交通大学医学院附属上海儿童医学中心儿科转化医学研究所,上海200127

出　　处：《临床儿科杂志》2014年第10期912-917,共6页Journal of Clinical Pediatrics

基　　金：上海市浦东新区科委资助项目(No.PKJ2012-Y51)

摘　　要：目的探讨过敏性紫癜((Henoch-Schnlein purpura,HSP)患儿血清IgA1半乳糖基的缺失水平与其临床特点的相关性,以指导临床个体化治疗。方法根据临床症状和疗效将57例HSP患儿分为:非紫癜肾普通组(26例),包括已激素治疗(12例)和尚未激素治疗者(14例);HSP肾病组(7例);难治性HSP组(7例);治愈组(17例)。另选健康体检儿童24例作为对照值。以凝集素(lectin)亲和ELISA法及IgA1抗体亲和ELISA法分别检测HSP患儿和对照组血清IgA1半乳糖基的缺失水平及IgA1水平。结果 57例HSP患儿中,40例未治愈者的血清IgA1半乳糖基缺失水平均高于治愈组和对照组,差异有统计学意义(P均<0.05);而治愈组与对照组间的差异无统计学意义(P>0.05)。在HSP的各亚组中,HSP肾病组、非紫癜肾普通组和难治性HSP组的血清IgA1半乳糖基缺失水平均高于对照组;难治性HSP组高于非紫癜肾普通组,差异有统计学意义(P均<0.05)。HSP肾病组与难治性HSP组及与非紫癜肾普通组患儿间血清IgA1半乳糖基缺失水平的差异无统计学意义(P均>0.05)。非紫癜肾普通组中,尚未激素治疗组血清IgA1半乳糖基缺失水平高于已予激素治疗组,差异有统计学意义(P<0.05)。结论 IgA1半乳糖基的缺失水平可以客观反映HSP的疾病活动状况和疗效预期,尤其对于难治性HSP患儿,有望成为临床有效的生物监测靶标以决策和指导糖皮质激素以及免疫抑制剂在HSP患儿中的合理使用。Objective To explore the association of galactose-deifcient IgA1 levels with clinical features, and further to provide guidance for individualized treatment of HSP. Methods According to the clinical symptoms and curative effect, 57 children with HSP were divided into four groups：non-HSPN group （n=26）, HSPN group （n=7）, refractory HSP group （n=7） and remission group （n=17）. In non-HSPN group, 12 cases received glucorticoid therapy and 14 cases did not. Serum galactose-de-ifcient IgA1 （Gd-IgA1） concentrations were detected using a Helix aspersa-lectin-based enzyme-linked immunosorbent assay （ELISA）, and the total IgA1 levels were measured by ELISA. Results The serum Gd-IgA1 level was signiifcantly higher in 40 HSP children who were not cured than that in remission group and control group （P〈0.05）. However, there was no difference in Gd-IgA1 level between remission group and control group （P〉0.05）. Compared with the control group, the serum Gd-IgA1 level was signiifcantly higher in HSPN group, non-HSPN group and refractory HSP, and children with refractory HSP had signiifcantly higher Gd-IgA1 level than children in non-HSPN group （P〈0.05）. No signiifcant difference in Gd-IgA1 level was found either between HSPN group and refractory HSP group or between HSPN group and non-HSPN group （P〉0.05）. Furthermore, in non-HSPN group, the serum Gd-IgA1 level in HSP children who were not treated with glucorticoid was signiifcantly higher than that in HSP children treated with glucorticoid （P〈0.05）. Conclusions The serum Gd-IgA1 level is associated with the disease activ-ity and curative effect of HSP, especially in children with refractory HSP, and it is thus likely to be a new non-invasive disease activity marker for guiding the proper usage of glucocorticoid and immunosuppressants in HSP children.

关 键 词：过敏性紫癜 免疫球蛋白A1 半乳糖基缺失 儿童 

分 类 号：R725.5[医药卫生—儿科]