系统性红斑狼疮患儿血清抗内皮细胞抗体检测的临床意义  

The clinical significance of anti-endothelial cell antibody in children with systemic lupus erythematosus

作　　者：高岭 王莉 殷丝雨 刘丽莎 GAO Ling;WANG Li;YIN Si-yu;LIU Li-sha(Department of Clinical Laboratory,Children's Hospital of Nanjing Medical University,Nanjing 210008,China;Department of Medical Examination,Wannan Medical College,Wuhu 241002,China)

机构地区：[1]南京医科大学附属儿童医院检验科,南京210008 [2]皖南医学院医学检验系,芜湖241002

出　　处：《现代免疫学》2021年第5期392-396,共5页Current Immunology

基　　金：南京医科大学科技发展基金(NMUB2018115)。

摘　　要：为探讨抗内皮细胞抗体(anti-endothelial cell antibody, AECA)在系统性红斑狼疮(systemic lupus erythematosus, SLE)患儿外周血中的表达情况及其临床意义,采用间接免疫荧光法(indirect immunofluorescence analysis, IIF)检测35例SLE患儿外周血IgG-AECA的表达情况。患儿中活动期20例、缓解期15例,另选取15例择期手术患儿作为对照组,观察比较各组患儿外周血血清中IgG-AECA的表达情况,同时检测上述35例SLE患儿外周血中抗dsDNA抗体的表达情况。将35例SLE患儿根据外周血中IgG-AECA的表达情况分为IgG-AECA阳性组和IgG-AECA阴性组,分别观察两组患儿免疫功能、炎症反应和凝血功能等各项检测指标间的差异以及继发狼疮性肾炎(lupus nephritis, LN)和尿微量蛋白的表达情况。结果显示,对照组儿童外周血IgG-AECA均为阴性,SLE患儿IgG-AECA的阳性率(51%)明显高于对照组(P<0.05),且活动期SLE组患儿IgG-AECA的阳性率(70%)明显高于对照组(P<0.05);SLE患儿外周血dsDNA的阳性率为40%,IgG-AECA和dsDNA联合检测的阳性率提高至69%;IgG-AECA阳性组SLE患儿外周血中IgA、IgM、IgG水平,sIL-2R、IL-6和TNF-α水平,纤维蛋白降解产物(fibrin degradation products, FDP)和D-二聚体水平以及尿微量蛋白表达水平均高于IgG-AECA阴性组(P<0.05),而C4水平低于IgG-AECA阴性组(P<0.05)。该研究提示IgG-AECA与SLE患儿疾病活动性密切相关,其可通过介导免疫功能紊乱参与SLE的发病过程,并可导致患儿肾脏功能损伤,对LN的诊断具有临床指导意义。To investigate the expression of anti-endothelial cell antibody(AECA) in peripheral blood of children with systemic lupus erythematosus(SLE)and to evaluate its clinical significance for diagnosing SLE in children, 35 children with SLE(20 children in the active stage and 15 children in the remission stage), as well as 15 children for selective operation were included in this study. IgG-AECA and dsDNA were detected by indirect immunofluorescence analysis(IIF). Based on the results, children with SLE were divided into 2 groups: IgG-AECA positive group and IgG-AECA negative group, and incidence of lupus nephritis(LN) in those 2 groups was observed. Besides, the differences of immune function, inflammatory factors, coagulation indicator and urinary microprotein in those different groups were observed. The results showed that the frequency of IgG-AECA was increased in SLE group than in the controls(51% vs 0%, P<0.05), especially in the active stage(70%,P<0.05). The positive rate of dsDNA in the SLE group was 40%, and the positive rate of combined detection of IgG-AECA and dsDNA increased to 69%. The levels of IgA,IgM,IgG,sIL-2 R,IL-6,TNF-α, fibrin degradation products(FDP), D-dimer and urine microalbumin were higher in IgG-AECA positive group than those in IgG-AECA negative group(P<0.05). The levels of C4 was lower in IgG-AECA positive group than those in IgG-AECA negative group(P<0.05). IgG-AECA may be involved in the pathogenesis of SLE, especially LN through mediating immune disorder, inflammatory factors release, coagulation disorders. In conclusion, serum level of IgG-AECA was closely related to disease activity in children with SLE and may be useful for the diagnosis of SLE, and elevated IgG-AECE level has a certain predictive value for LN in those patients.

关 键 词：系统性红斑狼疮 狼疮性肾炎 抗内皮细胞抗体 肾功能 

分 类 号：R725.5[医药卫生—儿科]