摘要目的 探讨抗角蛋白抗体(AKA)、抗核周因子(APF)及抗环瓜氨酸肽抗体(ACPA)3种关节炎抗体在幼年特发性关节炎(JIA)的早期分型诊断意义,以及其与预后的关系.方法 采用回顾性研究收集2013年12月至2016年6月首都儿科研究所附属儿童医院住院诊断为JIA,治疗并随访超过1年的患儿144例,其中男66例(46％),女78例(54％),诊断时年龄1岁5个月至15岁9个月.在诊断初期,进行AKA、ACPA、APF、TNFα等指标的检测.应用卡方检验或Fisher精确检验比较不同亚型之间3种抗体的阳性率;并分别应用Mann-Whitney非参数检验以及卡方检验或Fisher精确检验分析抗体阳性组与抗体阴性组之间预后的差异.结果 144例患儿中,全身型49例(34％);多关节炎型28例(19.4％);少关节炎型61例(42.3％);附着点炎相关型6例(4.2％).诊断初期检测3种抗体,任一抗体或联合抗体阳性者共52例(36.1％),其中AKA阳性者14例(9.7％),ACPA阳性者44例(30.6％),APF阳性者12例(8.3％).ACPA、AKA、APF3种抗体阳性检出率在不同亚型之间对比,差异有统计学意义(χ2分别为33.863、26.860、14.395,P分别为<0.01、<0.01、<0.05);多关节炎型3种抗体阳性检出率均高于全身型及少关节炎型;非全身型患儿95例中,抗体阳性组诊断初期细胞因子TNFα水平高于抗体阴性组(Z=4.785,P<0.01);144例患者随访1年,抗体阳性组与抗体阴性组相比,应用生物制剂治疗者(50％vs 25％)以及关节畸形者(17.3％vs 2.2％)、重要关节(髋关节及中轴关节)受累者(59.6％vs 14.1％)例数明显增多,差异有统计学意义(χ2分别为9.249、10.875、32.392,P均为<0.01);同时,抗体阳性组患儿受累关节数(7.07±3.85)个明显多于抗体阴性组患儿(2.31±1.64)个(F=63.822,P<0.01).结论 AKA、APF及ACPA这3种关节炎抗体是JIA早期分型诊断的重要血清学依据,并可能与JIA患儿预后相关.

abstractsObjective To investigate the early typing diagnostic and predictive value of anti-keratin antibodies(AKA), anti-perinuclear factor(APF) and anti-citrullinated protein antibodies(ACPA) in patients of juvenile idiopathic arthritis (JIA). Methods A retrospective study was conducted to collect 144 cases of JIA who were hospitalized in Capital Institute of Pediatrics from December 2013 to June 2016 and followed up for at least one year.Among them,66 were males (46％) and 78 were females (54％).The age at diagnosis was between 1 year 5 months to 15 years 9 months.144 patients were tested for AKA,ACPA,APF and TNFα upon admission. Chi-square test or Fisher exact test were used to compare the positive rates of three antibodies among different subtypes. Mann-Whitney nonparametric test and Chi-square test or Fisher exact test were used to analyze the data of prognosis between antibody-positive group and antibody-negative&nbsp;group in the course of disease. Results In 144 patients, 49(34％) were classified as systemic arthritis, 28 (19.4％) as polyarthritis, 61(42.3％) as oligoarthritis, and 6(4.2％) as enthesitis-associated arthritis. 52 cases (36.1％) were positive for one antibody or more antibodies of AKA/APF/ACPA at the early stage,14(9.7％) were AKA positive, 44(30.6％) were ACPA positive and 12(8.3％) were APF positive. The positive rates of ACPA/AKA/APF antibodies were significantly different among different subtypes(χ2=33.863,26.860,14.395;P<0.01,<0.01,<0.05).The rates in polyarthritis were higher than those in systemic arthritis and oligoarthritis;In 95 children with non-systemic form,the level of TNFαin antibody-positive group(43 cases)was higher than that in antibody-negative group(52 cases)at the early stage(Z=4.785, P<0.01);144 patients were followed up for at least one year,the rates of patients who accepted biologic therapies were significantly different between antibody-positive group and antibody-negative group (50％ vs 25％). So do the rates of patients with joint deformities(17.3％vs 2.2％)and with important joints involvement (hip and axis joints)(59.6％vs 14.1％)(χ2=9.249, 10.875, 32.392; P<0.01, <0.01, <0.01). Further more, the number of joints involved in the antibody-positive group (7.07 ± 3.85) was significantly more than that in the antibody-negative group (2.31 ± 1.64)(F=63.822,P<0.01). Conclusions AKA,APF and ACPA are important in the early typing diagnosis of JIA,and may be closely related to the prognosis of patients with JIA.