儿童系统性红斑狼疮脏器受累与自身抗体相关性研究  

The organ involvement and autoantibodies in children with systemic lupus erythematosus

作　　者：李士朋[1] 薛媛 邝伟英[1] 邓江红[1] 张俊梅[1] 檀晓华[1] 李超[1] 李彩凤[1] Li Shipeng;Xue Yuan;Kuang Weiying;Deng Jianghong;Zhang Junmei;Tan Xiaohua;Li Chao;Li Caifeng(Department of Rheumatology,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心、首都医科大学附属北京儿童医院风湿科,北京100045

出　　处：《中华风湿病学杂志》2022年第11期750-757,共8页Chinese Journal of Rheumatology

摘　　要：目的研究儿童SLE的自身抗体表达谱,并对脏器受累与自身抗体相关性进行探讨。方法选取2006年6月年至2020年10月在北京儿童医院住院初次确诊SLE且有完整的我院自身抗体检测项目及临床资料的患儿581例。对临床表现及自身抗体相关性进行相关性研究。采用χ^(2)或Fisher′s确切概率检验进行组间率的比较,以P<0.05为差异有统计学意义。结果本研究纳入581例SLE患儿,男女比例1∶3.6,平均诊断年龄(10.6±2.8)岁。以皮疹(388例,66.8%)、发热(335例,57.7%)、关节肿痛(170例,29.3%)为主要表现。最常受累脏器为血液系统(414例,71.3%),其次为LN(257例,44.2%)和关节炎(170例,29.3%)。本研究中ANA阳性率为100%(581例),抗dsDNA抗体、抗Sm抗体阳性率分别为59.7%(347例)和21.2%(123例)。抗dsDNA抗体阳性患儿比抗dsDNA抗体阴性患儿更容易出现发热表现(64.6%与47.4%,χ^(2)=16.77,P<0.001),肾脏(53.3%与30.8%,χ^(2)=28.80,P<0.001)和血液系统(76.1%与64.1%,χ^(2)=9.79,P=0.002)也易受累。抗SSB抗体阳性患者肾脏受累(27.8%与47.5%,χ^(2)=12.69,P<0.001)、血液系统(57.7%与74.0%,χ^(2)=10.40,P=0.001)、肺受累(12.4%与21.1%,χ^(2)=3.88,P=0.049)、心脏受累(9.3%与17.8%,χ^(2)=4.11,P=0.042)的比例低于抗SSB抗体阴性患者。抗组蛋白抗体阳性患者易出现LN(56.9%与36.6%,χ^(2)=22.62,P<0.001)、关节炎(37.6%与24.2%,χ^(2)=11.77,P=0.001)和肺受累(24.3%与16.8%,χ^(2)=4.87,P=0.027)。抗Sm抗体阳性患者易出现蝶形红斑(52.8%与31.7%,χ^(2)=11.38,P<0.001)、日光过敏(13.8%与7.4%,χ^(2)=4.96,P=0.026)等皮肤表现,但关节受累(22.0%与31.2%,χ^(2)=4.03,P=0.045)、血小板降低(17.1%与27.3%,χ^(2)=5.38,P=0.026)比例低于抗Sm抗体阴性患儿。RF因子阳性患儿易出现关节炎(44.4%与24.8%,χ^(2)=19.00,P<0.001)、继发性SS(28.6%与5.4%,χ^(2)=57.98,P<0.001)及腮腺受累(25.6%与2.9%,χ^(2)=70.84,P<0.001),但肾脏受累(30.8%与48.2%,χ^(2)=12.57,P<0.001)比例低于RF阴性患儿。结论�Objective To explore the correlation between autoantibodies and organ involvement in children with systemic lupus erythematosus(SLE).Methods From June 2006 to October 2020,581 children with SLE who were hospitalized in Beijing Children's Hospital for the first time and had autoantibody detection and clinical data in our hospital were selected.A correlation study was carried out on the clinical manifestations and autoantibodies.Data were analyzed with Pearsonχ^(2) or Fisher's exact test.P<0.05 was considered statistically significant.Results A total of 581 children with SLE were included in this study,with a male to female ratio of 1∶3.6.The average age at diagnosis was(10.6±2.8)years,and the main symptoms were rash(388,66.8%),fever(335,57.7%),and joint swelling and pain(170,29.3%).The most commonly affected organ is the blood system(414,71.3%),followed by lupus nephritis(257,44.2%)and arthritis(170,29.3%).In this study,the positive rate of ANA was 100%,and the positive rates of anti-dsDNA antibody and anti-Sm antibody were 59.7%and 21.2%,respectively.The children with anti-dsDNA antibody positive were more likely to have fever(64.6%vs 47.4%,χ^(2)=16.77,P<0.001),and the kidneys(53.3%vs 30.8%,χ^(2)=28.80,P<0.001)and blood systems(76.1%vs 64.1%,χ^(2)=9.79,P=0.002)were more likely to be involved than anti-dsDNA antibody negative.The proportion of renal involvement(27.8%vs 47.5%,χ^(2)=12.69,P<0.001),blood system(57.7%vs 74.0%,χ^(2)=10.40,P=0.001),lung involvement(12.4%vs 21.1%,χ^(2)=3.88,P=0.049)and cardiac involvement(9.3%vs 17.8%,χ^(2)=4.11,P=0.042)in patients with anti-SSB antibody positive were lower than those in patients with anti-SSB antibody negative.Anti-histone antibody-positive patients were prone to lupus nephritis(56.9%vs 36.6%,χ^(2)=22.62,P<0.001),arthritis(37.6%vs 24.2%,χ^(2)=11.77,P=0.001)and lung involvement(24.3%vs 16.8%,χ^(2)=4.87,P=0.027).Anti-Sm antibody positive patients were prone to skin manifestations such as butterfly erythema(52.8%vs 31.7%,χ^(2)=11.38,P<0.001)and sunlight alle

关 键 词：儿童 红斑狼疮 系统性 自身抗体 

分 类 号：R725.9[医药卫生—儿科]