Clinical significance of the antinuclear antibody test in selected children with idiopathic thrombocytopenic purpura.
Clinical significance of the antinuclear antibody test in selected children with idiopathic thrombocytopenic purpura.
复制标题
特发性血小板减少性紫癜特定儿童抗核抗体检测的临床意义。
DOI：
10.1097/00043426-199707000-00006
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
Ware,RE
中科院分区：
文献类型：
--
作者：
Zimmerman,SA;Ware,RE
目的探讨抗核抗体（ANA）检测在特发性血小板减少性紫癜（ITP）患儿中的临床意义。方法本研究通过回顾性病历分析和长期电话随访进行。ANA阳性的儿童更有可能是年龄较大的女孩，他们更容易发展为慢性ITP，但与自身免疫性疾病家族史、初始血红蛋白浓度或初始血小板计数无关。平均随访超过5年，ANA阳性儿童比ANA阴性儿童发展出更多的自身免疫性症状（36% vs. 0%，p< 0.001）。9名ANA阳性的儿童出现了额外的自身免疫性症状，其中5名具有足以诊断系统性红斑狼疮（SLE）的临床标准。抗dsDNA自身抗体在自身免疫症状进展的儿童中更普遍（57% vs. 0%，p= 0.04）。除ANA外，任何自身抗体的存在，包括dsDNA、SS-A/Ro、SS-B/La、Smith抗原（Sm）、核核糖核蛋白（nRNP）或心磷脂，在有进一步自身免疫症状的儿童中更为常见（75%vs.0%，p= 0.003）.结论ANA是一个有用的筛选试验在一个子集的儿童ITP，特别是年龄较大的女孩与慢性ITP，他们有患全身性自身免疫病的风险。患有ITP和ANA阳性的儿童应接受仔细的随访。
PurposeTo determine the clinical significance of the antinuclear antibody (ANA) test in selected children with idiopathic thrombocytopenic purpura (ITP).MethodsThe study was conducted through retrospective chart review and long-term follow-up by telephone interview.ResultsOf 87 children with ITP who had an ANA performed, 25 had a positive titer (median= 1: 160, range: 1: 40 to 1: 2,560). Children with a positive ANA were more likely to be older girls who developed chronic ITP, but there was no correlation with family history of autoimmune disease, initial hemoglobin concentration, or initial platelet count. With an average follow-up of more than 5 years, more children with a positive ANA developed further autoimmune symptoms than those with a negative ANA (36% vs. 0%, p< 0.001). Nine children with a positive ANA developed additional autoimmune symptoms, including five with clinical criteria sufficient for the diagnosis of systemic lupus erythematosus (SLE). Autoantibodies to dsDNA were more prevalent in the children with progression of autoimmune symptoms (57% vs. 0%, p= 0.04). The presence of any autoantibody in addition to the ANA, including dsDNA, SS-A/Ro, SS-B/La, Smith Antigen (Sm), nuclear ribonucleoprotein (nRNP), or cardiolipin was more common in children who had further autoimmune symptoms (75% vs. 0%, p= 0.003).ConclusionsThe ANA is a useful screening test in a subset of children with ITP, especially older girls with chronic ITP, who are at risk for the development of generalized autoimmune disease. Children with ITP and a positive ANA should receive careful follow-up.