背景:在成人文献中,组蛋白抗体与系统性红斑狼疮(SLE)和药物诱导的狼疮(DILE)相关。关于针对组蛋白的抗体在儿科人群中涵盖的病理学谱的数据很少。先前的研究表明与SLE有关,幼年特发性关节炎(JIA),葡萄膜炎和线状硬皮病。
方法:回顾了连续三年内抗组蛋白抗体检测阳性的患者图表。患者诊断以及存在:抗组蛋白抗体滴度,安娜,以及其他SSA自身抗体的存在,SSB,Sm,RNP,获得dsDNA和染色质。SLE的频率,在特定的亚群中进一步研究了JIA和DILE。
结果:回顾了139个包含41种不同诊断的单独图表。最常见的诊断是活动过度关节痛,有22例患者。最常见的风湿病诊断是JIA(非全身性),有19。这项研究中的13例患者被诊断为SLE,2例被诊断为DILE。18例患者有其他自身抗体产生,其中,11患有SLE或DILE。62例抗组蛋白抗体滴度(1.0-1.5)弱的患者中只有1例被诊断为SLE。当存在强滴度(>2.5)时,抗组蛋白抗体检测与基础风湿病的发病率超过50%相关,SLE的发病率是滴度弱的10倍.关于SLE的频率,弱滴度和中度滴度之间以及弱滴度和强滴度之间存在统计学上的显着差异。
结论:在儿科人群的多种诊断中观察到抗组蛋白抗体的存在。总的来说,抗组蛋白抗体的存在似乎对任何特定疾病的诊断效用都较差.然而,SLE的诊断实用程序似乎随着更高的滴度而提高,当与其他自身抗体阳性。效价强度似乎不是JIA的一个因素,但却是本研究中最常见的风湿性疾病。
BACKGROUND: Antibodies to
histone have been associated in the adult literature with systemic lupus erythematosus(SLE) and drug induced lupus(DILE). Little data is available regarding the spectrum of pathology that antibodies to
histone encompass in the pediatric population. Prior studies suggest an association with SLE, juvenile idiopathic arthritis(JIA), uveitis and linear scleroderma.
METHODS: Patient charts were reviewed that contained positive anti-
histone antibody testing during a consecutive three year period. Patient diagnosis along with the presence of: anti-
histone antibody titer, ANA, and the presence of other autoantibodies to SSA, SSB, Sm, RNP, dsDNA and chromatin were obtained. The frequency of SLE, JIA and DILE was further investigated in specific subsets.
RESULTS: 139 individual charts were reviewed containing 41 different diagnoses. The most common diagnosis was hypermobility arthralgia with 22 patients. The most frequent rheumatologic diagnosis was JIA(nonsystemic) with 19. 13 patients in this study were diagnosed with SLE and 2 with DILE. 18 patients had other autoantibody production, of these, 11 had SLE or DILE. Only one of 62 patients with a weak antihistone antibody titer(1.0-1.5) was diagnosed with SLE. When strong titers are present(> 2.5), the antihistone antibody test was associated with a greater than 50% incidence of an underlying rheumatologic disease and ten times higher incidence of SLE than a weak titer. In regards to the frequency of SLE, there was a statistically significant difference between weak and moderate titers and between weak and strong titers.
CONCLUSIONS: The presence of anti-
histone antibody was observed in a variety of diagnoses in the pediatric population. Overall, the presence of anti-histone antibodies appears to have poor diagnostic utility for any specific condition. However, diagnostic utility for SLE does appear to improve with higher titers, when combined with other autoantibody positivity. Strength of titer did not appear to be a factor for JIA, but was the most frequently observed rheumatologic disease in this study.