抗中性粒细胞胞浆抗体在儿童过敏性紫癜早期肾脏损伤中的预测作用  

Predictive value of anti-neutrophil cytoplasmic antibodies in early renal injury in children with Henoch-Schonlein purpura

作　　者：潘伟 张爱华[2] PAN Wei;ZHANG Ai-hua(Department of Clinical Laboratory,Children's Hospital of Nanjing Medical University,Nanjing 210008,China;Department of Pediatric Nephrology,Children's Hospital of Nanjing Medical University,Nanjing 210008,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]南京医科大学附属儿童医院肾脏科,南京210008

出　　处：《现代免疫学》2023年第4期296-300,共5页Current Immunology

摘　　要：为验证抗中性粒细胞胞浆抗体(anti-neutrophil cytoplasmic antibody,ANCA)是过敏性紫癜(Henoch-Schonlein purpura,HSP)患儿早期肾脏损伤的预测指标,选择2152例HSP患儿为HSP组,根据是否有肾脏损伤又分为紫癜型HSP组(1977例)和肾炎型HSP组(175例),同时选择76例健康体检儿童为健康对照组。分析ANCA在各组儿童中的检出率,ANCA阳性与免疫球蛋白(IgG、IgM、IgA)、补体(C3、C4)及细胞免疫功能(CD3^(+)、CD3^(+)CD4^(+)、CD3^(+)CD8^(+)、CD3^(-)CD16^(+)CD56^(+)、CD3^(-)CD19^(+)细胞比例)之间的相互作用,检测患儿尿微量白蛋白(microalbumin,MA)、尿IgG、尿α1-微球蛋白(alpha 1-microglobulin,α1-MG),分析ANCA阳性与肾脏损伤的相关性。结果显示,HSP患儿ANCA阳性176例(8.18%),健康对照组儿童ANCA均为阴性。ANCA阳性HSP患儿IgG、IgM、IgA、C3、C4水平及CD3^(-)CD19^(+)细胞比例均显著高于健康对照组(P<0.01),CD3^(+)、CD3^(+)CD4^(+)、CD3^(-)CD16^(+)CD56^(+)细胞比例均显著低于健康对照组(P<0.01),CD3^(+)CD8^(+)细胞比例2组间差异无统计学意义(P>0.05),紫癜型HSP和肾炎型HSP患儿间各指标差异均无统计学意义(P>0.05)。ANCA阳性组HSP患儿尿MA、尿IgG、尿α1-MG水平显著高于ANCA阴性组(P<0.05)。该研究提示,ANCA阳性与HSP患儿的体液免疫功能增强以及细胞免疫功能降低有关,ANCA可能是一个预测HSP患儿早期肾脏损伤的生物学指标。The aim of this study is to verify the predictive value of anti-neutrophil cytoplasmic antibodies(ANCA)in early renal injury in children with Henoch-Schonlein purpura(HSP).Children with HSP(n=2152)were selected as HSP group which was further divided into purpura type HSP group(n=1977)and nephritis type HSP group(n=175)based on the presence of renal injury.Meanwhile,76 healthy children were selected as healthy control.The ANCA positive rates were analyzed,as well as the reciprocal relationship between ANCA positivity and immune function,including immunoglobulin(IgG,IgM,IgA),complement(C3,C4),and cellular immunity(the percentages of CD3^(+),CD3^(+)CD4^(+),CD3^(+)CD8^(+),CD3^(-)CD16^(+)CD56^(+),CD3^(-)CD19^(+)cell).Urinary microalbumin(MA),urinary IgG,and urine alpha 1-microglobulin(α1-MG)were measured to explore the association between ANCA and renal injury.The results showed that 176 out of 2152 children with HSP were ANCA positive(8.18%)whereas all healthy children were ANCA negative.The levels of IgG,IgM,IgA,C3,C4,and the percentage of CD3^(-)CD19^(+)cells in HSP children with positive ANCA were significantly higher than those in the healthy control group(P<0.01)whereas the percentages of CD3^(+),CD3^(+)CD4^(+),CD3^(-)CD16^(+)CD56^(+)cells were significantly decreased than those in the healthy control group(P<0.01).There was no significant difference in the percentage of CD3^(+)CD8^(+)cells between the two groups(P>0.05).And there was no significant difference in all the indices between purpura and nephritis type HSP(P>0.05).The levels of urinary MA,urinary IgG,and urineα1-MG in ANCA-positive HSP children were significantly higher than those in ANCA-negative HSP children(P<0.05).In conclusion,positive ANCA is associated with enhanced humoral immunity as well as decreased cellular immunity in children with HSP.ANCA may be a predictive biological indicator for early renal injury in children with HSP.

关 键 词：过敏性紫癜 抗中性粒细胞胞浆抗体 体液免疫 细胞免疫 

分 类 号：R729[医药卫生—儿科]