摘要
目的分析致密细斑点型抗核抗体(DFS)阳性患儿的临床特点及实验室检查指标差异,探讨DFS阳性在儿童免疫性疾病诊断中的价值。方法回顾性分析2017年8月至2020年2月9613例行抗核抗体(ANA)常规检测的儿童,其中197例DFS阳性,根据临床诊断分为自身免疫性疾病(AID)组(39例)和非AID组(158例),同期体检健康儿童作为健康对照组(40例)。采用t检验比较AID组与非AID组体液免疫等临床指标的检出差异,并比较DFS阳性病例在不同临床科室分布、首发症状、累及部位等差异。结果9613例儿童行自身抗体检测,ANA阳性2654例(27.61%),其中斑点型检出最高,DFS阳性197例,在ANA阳性儿童中占7.42%;97例DFS阳性男童占ANA阳性男童的8.20%(97/1183例);100例DFS阳性女童占ANA阳性女童的6.80%(100/1471例),男女阳性检出率差异无统计学意义;ANA检出阳性占比较高科室为肾脏科(27.88%)、风湿免疫科(24.83%);而DFS阳性患儿检出率较高的科室为消化科(13.25%)、感染科(11.76%)。DFS抗体阳性患儿中,AID为39例,其中器官特异性AID患儿38例,幼年特发性关节炎(JIA)检出最高为13例;在158例非AID患儿中DFS阳性较高的疾病为过敏性紫癜(HSP)(46例);AID组患儿血清免疫球蛋白G(IgG)水平明显低于非AID组患儿;AID患儿血清IgM、C4水平明显低于非AID组及健康对照组儿童;DFS阳性患儿血清IgA水平明显高于健康对照组。DFS抗体阳性患儿全部无特异性自身抗体。结论DFS抗体阳性对排除儿童系统性AID有重要意义,通过DFS及其他自身免疫抗体、体液免疫功能指标等联合检测,有助于早期鉴别诊断儿童AID。
Objective To analyze the differences of the clinical characteristics and laboratory indexes in children with positive dense fine spot(DFS)type anti-nuclear antibody,and thereby to explore the value of positive DFS in the diagnosis of immunological diseases.Methods Among 9613 cases who were routinely tested for antinuclear antibody(ANA)from August 2017 to February 2020,there were 197 cases with DFS positive,who were subjected to a retrospective analysis.These patients were divided into the autoimmune diseases(AID)group(39 cases)and the non-AID group(158 cases)according to clinical diagnosis.Healthy children in the same physical examination were used as healthy control group(40 cases).T test was applied to analyze the differences of humoral immunity markers between AID and non-AID groups.What′s more,DFS positive patients in different clinical departments,initial symptom and the part of body were further compared.Results Among 9613 children tested for autoantibodies,2654(27.61%)were ANA positive,with the highest detection rate of the spotted type and 197 DFS positive cases,accoun-ting for 7.42%of ANA positive children;97 DFS positive male patients accounted for 8.20%(97/1183 case)of ANA positive male patients,100 DFS positive female patients accounted for 6.80%(100/1471 cases)of ANA positive female patients,and there was no significant difference in the positive rate.The departments with high positive ANA detection included the nephrology department(27.88%)and the rheumatology department(24.83%).The departments with a higher ANA positive rate in DFS positive children included the gastroenterology department(13.25%)and the infectious department(11.76%).Among the children with DFS antibody positive,39 cases had AID,among which 38 cases had organ-specific AID,and juvenile idiopathic arthritis(JIA)had the highest detection rate in 13 cases.The diseases with a high DFS positive rate in 158 non-AID cases included allergic purpura(46 cases).Serum immunoglobulin(IgG)level in the AID group was significantly lower than this in the non-AID group,serum IgM and C4 levels in AID children were significantly lower than those in the non-AID group and healthy control group,and the serum IgA level of DFS positive group was significantly higher than that of children in the healthy control group.All children with DFS antibody positive had no specific autoantibodies.Conclusions DFS antibody positive is important for the diagnosis of systemic AID in children.The combined detection with the DFS,other autoimmunity antibody index,humoral immune function index contributes to the early differential diagnosis of autoimmune diseases in children.
作者
高岭
桂珍
刘丽莎
曹彤
陈红兵
徐飞
Gao Ling;Gui Zhen;Liu Lisha;Cao Tong;Chen Hongbing;Xu Fei(Department of Laboratory,Children′s Hospital of Nanjing Medical University,Nanjing 210008,China)
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2022年第1期27-31,共5页
Chinese Journal of Applied Clinical Pediatrics
基金
南京市科委(社发)(201823013)。
作者简介
通信作者:徐飞,Email:feixu1975@126.com。
