抗核抗体在儿童过敏性紫癜发病中的作用  

Role of antinuclear antibodies in the pathogenesis of Henoch-Schnlein purpura in children

作　　者：邵惠江[1] 邵雪君[1] 季正华[1] 计雪强[1] 薛建[1] 朱云芬[1] 缪美华[1] 

机构地区：[1]苏州大学附属儿童医院检验科,江苏苏州215025

出　　处：《江苏大学学报（医学版）》2017年第6期478-482,共5页Journal of Jiangsu University：Medicine Edition

摘　　要：目的:研究抗核抗体在儿童过敏性紫癜(Henoch-Sch9nlein purpura,HSP)发病中的作用。方法:回顾性分析临床HSP患儿病史,并分成紫癜型、关节型、腹型和肾炎型HSP;同时收集健康体检儿童血样。分析抗核抗体滴度及抗核抗体谱在HSP以及不同临床亚型中的检出率,抗核抗体阳性对体液免疫(C3、C4、Ig A、Ig G、Ig M)及细胞免疫(CD3^+、CD3^+CD4^+、CD3^+CD8^+、CD3-CD19^+、CD19^+CD23^+、CD3-CD16^+CD56^+细胞)的影响,体液免疫、细胞免疫对抗核抗体阳性的影响。结果:共收集同龄健康体检儿童82例,HSP患儿436例。HSP患儿抗核抗体阳性66例(15.14%),其中关节型HSP 17例,紫癜型HSP 25例,腹型HSP 13例,肾炎型HSP 11例;抗核抗体滴度介于1∶100~1∶320,抗核抗体谱阳性介于弱阳性及阳性之间。抗核抗体在HSP不同临床亚型之间的检出率差异无统计学意义(P=0.213)。抗核抗体阳性HSP患儿的Ig A、Ig G、Ig M水平较健康对照明显升高(P均<0.01),补体C3、C4差异无统计学意义(P>0.05);细胞免疫中HSP患儿CD3^+、CD3^+CD4^+和CD3-CD16^+CD56^+细胞比例显著下降(P分别为<0.01、<0.01、0.009),而CD3^+CD8^+、CD3-CD19^+和CD19^+CD23^+细胞显著升高(P分别为0.011、<0.01、<0.01)。将各HSP临床亚型患儿根据抗核抗体结果分为自身抗体阳性和阴性两组,结果显示两组体液和细胞免疫各指标的差异均无统计学意义(P均>0.05)。Logistic回归分析显示,体液免疫及细胞免疫指标均不是影响抗核抗体阳性的主要因素。结论:抗核抗体阳性不是影响HSP患儿体液免疫及细胞免疫的主要因素,HSP患儿免疫功能的变化也不是影响抗核抗体阳性的主要因素;HSP患儿中低滴度或非强阳性抗核抗体可能是自身免疫机制中产生的非特异性抗体。Objective: To study the role of antinuclear antibodies( ANA) in the pathogenesis of Henoch-Sch9 nlein purpura( HSP) in children. Methods: Clinical HSP children were reviewed and divided into purpura type,joint type,abdominal and nephritis HSP; meanwhile,blood samples were collected from healthy children receiving physical examination. The results of ANA titer and ANA profiles in HSP and all four subtypes were analyzed,as well as reciprocal relationship of immune function and the positivity of ANA,including the influence of humoral immunity( C3,C4,Ig A,Ig G,Ig M) and cellular immunity( CD3^+,CD3^+CD4^+,CD3^+CD8^+,CD3-CD19^+,CD19^+CD23^+,CD3-CD16^+CD56^+cells) caused by ANA,and the influence of ANA to the changes of humoral immunity and cellular immunity. Results: A total of 82 healthy controls and 436 children with HSP were collected. In HSP,66( 15. 14%) were positive for ANA,including 17 cases of articular HSP,25 cases of purpura type HSP,13 cases of abdominal type HSP and 11 cases of nephritis; The titers of ANA lied between 1 ∶ 100-1 ∶ 320,and the positivity spec-trum of specific ANA lied between the weak positive and positive. There was no statistically significant difference in the detection rate of ANA between different clinical subtypes of HSP( P = 0. 213). The quantity of Ig A,Ig G and Ig M in HSP children with positivity of ANA were significantly higher than those in normal controls( P < 0. 01),and there was no significant difference in complement C3 and C4( P > 0. 05).For cellular immunity,CD3^+,CD3^+CD4^+and CD3-CD16^+CD56^+cells were significantly decreased in this ANA positive HSP group( P < 0. 01, < 0. 01,0. 009 respectively),while CD3^+CD8^+,CD3-CD19^+and CD19^+CD23^+cells were significantly increased( P = 0. 011,< 0. 01,< 0. 01 respectively). By divided HSP children into ANA positive and negative groups,there were no significant differences in the effects of autoantibody on humoral immunity and cellular immunity( P > 0. 05). Logistic regression analysis showed that indicators of humoral immunit

关 键 词：过敏性紫癜 儿童 抗核抗体 体液免疫 细胞免疫 

分 类 号：R554.6[医药卫生—血液循环系统疾病]