Henoch-Schönlein 자반증에서 항인지질 항체의 임상적 의의
The Clinical Significance of Antiphospholipid Antibodies in Korean Children with Henoch-Schönlein Purpura
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목 적 : Henoch-Schönlein 자반증에서 항인지질 항체에 대한 연구가 외국에서 몇몇 보고되고 있지만 국내에서는 소아 환자를 대상으로 한 연구가 거의 없는 실정이며 또한 항인지질 항체가 양성인 그룹과 음성인 그룹을 비교하여 연구한 논문은 아직 없는 상태이다. 따라서 한국 소아 Henoch-Schönlein 자반증에서 항인지질 항체가 양성인 환아의 항인지질 항체의 임상적 의의를 알아보고자 본 연구를 시행하였다. 방 법 : 2007년 1월부터 2009년 6월까지 신촌 세브란스 병원 소아청소년과에 내원하여 Henoch- Schönlein 자반증으로 진단받은 62명의 환아를 대상으로 의무기록을 후향적으로 조사하여 분석하였다. 환아의 일반적인 특징으로 성별, 나이, 복통, 관절통과 자반증 등의 임상 증상을 조사하였고, 검사 소견으로는 백혈구수, 혈색소, 혈소판수, 호산구수, C-반응 단백, 혈침 속도, 단백뇨, 대변 잠혈 검사, 혈청 면역 글로불린(IgG, IgA, IgM, IgE), 혈청 보체(C3, C4), 항핵 항체(ANA), 알부민과 항인지질 항체(루프스 항응고인자, 항카디오리핀 항체, 항β 2GPI 항체) 등을 조사하였다. 결 과 : 총 62명의 환아중 남녀 각각 31명이었고 평균 연령은 6.0± 3.1세(범위: 1-16세)였다. 루프스 항응고인자 양성인 그룹과 음성인 그룹으로 나누어 비교한 결과 복통, 자반증, 관절통, 신염 등의 임상 증세에서는 두 그룹 간에 통계적으로 유의한 차이가 없는 걸로 나타났으나 검사 소견을 비교하였을 때 양성인 그룹에서 C-반응 단백(4.3± 7.2 mg/dL vs. 1.3± 1.8 mg/dL, P=0.035), 혈침 속도(37.5± 26.2 mm/hr vs. 25.1± 22.6 mm/hr, P=0.039), IgM (148.1± 48.4 mg/dL vs. 114.9± 41.5 mg/dL, P= 0.024), C3 (143.1± 21.9 mg/dL vs. 129.7± 24.5 mg/ dL, P=0.048), C4 (30.9± 6.3 mg/dL vs. 24.9± 7.8 mg/dL, P=0.002)가 통계학적으로 유의하게 높았다. 결 론 : Henoch-Schönlein 자반증에서 루프스 항응고인자는 29%에서 양성 소견을 보였으며 양성인 그룹에서 염증 인자인 C-반응단백, 혈침 속도 그리고 IgM, C3, C4 수치가 유의하게 높게 측정되었다. 이것은 루프스 항응고인자가 Henoch-Schönlein 자반증에서 질병의 활성과 병인에 어떤 역할을 수행함을 암시한다고 볼 수 있다.
Abstract
Purpose : We performed this study to evaluate the incidence and clinical significance of antiphospholipid antibodies (aPL Ab) in Korean children with Henoch-Schönlein purpura (HSP). Methods : The medical records of 62 patients (31 boys and 31 girls) aged 6.0± 3.1 (1-16) years with a clinical diagnosis of HSP based on the EULAR/PReS criteria were reviewed retrospectively. From the years 2007 to 2009, the sera from children with acute HSP were tested for aPL Ab such as LA, anti-cardiolipin antibody and anti-β 2 glycoprotein I antibody. Results : LA was positive in 18 (29%) of the 62 patients with HSP and We divided the patients into the two groups LA positive group (N=18) and LA negative group (N=44). There were no significant differences between the two groups with regard to abdominal pain, arthralgia and renal involvement, but LA positive group had significantly higher C-reactive protein (4.3± 7.2 mg/dL vs. 1.3± 1.8 mg/dL, P=0.035), erythrocyte sedimentation rate (37.5± 26.2 mm/hr vs. 25.1± 22.6 mm/hr, P= 0.039), IgM (148.1± 48.4 mg/dL vs. 114.9± 41.5 mg/dL, P=0.024), C3 (143.1± 21.9 mg/dL vs. 129.7± 24.5 mg/dL, P=0.048) and C4 levels (30.9± 6.3 mg/dL vs. 24.9± 7.8 mg/dL, P=0.002) compared with LA negative group. Conclusion : We found that the incidence of positive aPL Ab tests was relatively higher in Korean children with HSP and the presence of aPL Ab was associated with acute inflammatory process of HSP. These results suggest that the aPL Ab are involved in the pathogenesis of HSP in children.
참고문헌 (25)
- Yang YH, "The immunobiology of Henoch-Schonlein purpura", Autoimmun Rev, 7, pp.179~184 (2008)
- Ballinger S, "Henoch-Schonlein purpura", Curr Opin Rheumatol, 15, pp.591~594 (2003)
- Avcin T, "Antiphospholipid syndrome in children", Curr Opin Rheumatol, 20, pp.595~600 (2008)
- Briones M, "Lupus anticoagulants in children", Curr Opin Hematol, 10, pp.375~379 (2003)
- Monastiri K, "Primary antiphospholipid syndrome presenting as complicated Henoch-Schonlein purpura", Arch Dis Child, 86, pp.132~133 (2002)
- Abend NS, "Lupus anticoagulant and thrombosis following Henoch- Schönlein purpura", Pediatr Neurol, 36, pp.345~347 (2007)
- Ozen S, "EULAR", PReS endorsed consensus criteria for the classification of childhood vasculitides, 2006, pp.65, 936~941
- Szer IS, "Henoch-Schonlein purpura", rr Opin Rheumatol, 6, pp.25~31 (1994)
- Avcin T, "Antiphospholipid antibodies in response to infection", Curr Rheumatol Rep, 9, pp.212~218 (2007)
- Levi M, "Measuring activated protein C in plasma to assess its role as a critical modulator of coagulation and inflammation", J Thromb Haemost, 1, pp.643~644 (2003)
- Hunt BJ, "Pediatric antiphospholipid antibodies and antiphospholipid syndrome", Semin Thromb Hemost, 34, pp.274~281 (2008)
- Norden DK, "Vasculitis associated with antiphospholipid syndrome", Semin Arthritis Rheum, 24, pp.273~281 (1995)
- Salhan M, "Antiphospholipid antibodies in children with Henoch-Schönlein purpura: a prospective study from North India", Scand J Rheumatol, 36, pp.482~484 (2007)
- Kawakami T, "High titer of serum antiphospholipid antibody levels in adult Henoch-Schonlein purpura and cutaneous leukocytoclastic angiitis", Rheum, 59, pp.561~567 (2008)
- Shin JI, "Lupus anticoagulant and IgM anti-phospholipid antibodies in Korean children with Henoch-Schonlein purpura", Scand J Rheumatol, 38, pp.73~74 (2009)
- Watanabe T, "Henoch-Schonlein purpura with antiphospholipid antibodies following an influenza vaccination", Pediatr Nephrol, 16, pp.458~459 (2001)
- Mormile R, "Henoch-Schonlein purpura with antiphospholipid antibodies after influenza vaccination: how fearful is it in children?", Vaccine, 23, pp.567~568 (2004)
- Gharavi EE, "Induction of antiphospholipid antibodies by immunization with synthetic viral and bacterial peptides", Lupus, 8, pp.449~455 (1999)
- Descloux E, "Paediatric systemic lupus erythematosus: prognostic impact of antiphospholipid antibodies", Rheumatology, 47, pp.183~187 (2008)
- Brunner HI, "Risk factors for damage in childhood-onset systemic lupus erythematosus: cumulative disease activity and medication use predict disease damage", Arthritis Rheum, 46, pp.436~444 (2002)
- Male C, "Predictive value of persistent versus transient antiphospholipid antibody subtypes for the risk of thrombotic events in pediatric patients with systemic lupus erythematosus", Blood, 106, pp.4152~4158 (2005)
- Kawakami T, "Elevated serum IgA anticardiolipin antibody levels in adult Henoch-Schonlein purpura", Br J Dermatol, 155, pp.983~987 (2006)
- Yang YH, "Increased transforming growth factor-beta (TGF-beta)-secreting T cells and IgA anti-cardiolipin antibody levels during acute stage of childhood Henoch-Schonlein purpura", Clin Exp Immunol, 122, pp.285~290 (2000)
- Tajima C, "Clinical significance of immunoglobulin A antiphospholipid antibodies: possible association with skin manifestations and small vessel vasculitis", J Rheumatol, 25, pp.1730~1736 (1998)
- Wahl DG, "Meta- analysis of the risk of venous thrombosis in individuals with antiphospholipid antibodies without underlying autoimmune disease or previous thrombosis", Lupus, 7, pp.15~22 (1998)