1 132例儿童系统性红斑狼疮患者血清抗核抗体谱表达水平与抗核抗体核型特征的分析研究OA

Objective To present a comprehensive landscape of anti-nuclear antibody(ANA)and ANA-profile test results in childhood-onset systemic lupus erythematosus(cSLE)and to provide reference data for the diagnosis and management of the disease.Methods A total of 1 132 cSLE children admitted to Tianjin Children's Hospital from January 2020 to December 2024 were enrolled.Gender,age,season,ANA fluorescence pattern,titre,and extractable nuclear antigen(ENA)reactivities were statistically analyzed to delineate the detailed serological characteristics of the cohort.Results Among the 1132 cSLE patients,female cases outnumbered male cases by a factor of 7.64.The number of cSLE cases gradually increased in children over 5 years of age,peaked in the 12～15 year age group,and gradually declined in the 16～18 year age group.The number of cSLE cases presenting for medical care was higher in summer than in other seasons.In this study,ANA in cSLE children exhibited 23 nuclear patterns or pattern combinations,and single patterns were predominantly nuclear speckled,homogeneous,cytoplasmic speckled,and nucleolar.The predominant ENA reactivities corresponding to the nuclear speckled pattern were,in descending order,dsDNA,SSA,RNP,P0,Sm and SSB;for the homogeneous pattern,they were dsDNA,His,P0,SSA,RNP and Sm;for the cytoplasmic speckled pattern,they were P0,Sm,RNP and dsDNA;and for the nucleolar pattern,they were dsDNA,RNP,P0 and SSA.The positive rates of ENA antibodies in cSLE children,ranked from highest to lowest,were dsDNA,SSA,P0,RNP,Sm,His,SSB,CB,and Jo-1,and the differences were statistically significant(χ2=1 719.840,P<0.05).The positive rate of dsDNA antibodies was higher in female than in male patients(χ2=6.932),whereas the positive rates of SSA and RNP antibodies were higher in male than in female patients(χ2=5.958 and 6.518,respectively),and the differences were statistically significant(all P<0.05).The positive rate of RNP antibodies was relatively higher in cSLE children aged≥10 years(χ2=6.271),while the positive rates of dsDNA and SSA antibodies were relatively high in children aged<10 years(χ2=4.782 and 9.024,respectively),and the differences were statistically significant(all P<0.05).A total of 200 cSLE children were negative for all ENA antibodies,and their distribution across various ANA titers was relatively even.Among cSLE children with 1 or 2 positive ENA antibodies,ANA was distributed across multiple titers,with the proportion at a titer of 1:1 280 being 34.45％(134/389)and 48.10％(114/237),respectively.Among cSLE children with 3 positive ENA antibodies,ANA titers were mostly concentrated at 1:320 and above,with 62％(93/150)at a titer of 1:1 280.Among those with 4～7 positive ENA antibodies,ANA titers were essentially concentrated at 1:1 280,accounting for 60％(3/5)to 86.76％(59/68).Conclusions Girls aged 12～15 years represent the predominant pediatric population affected by cSLE.ANA testing in cSLE exhibits marked heterogeneity.High ANA titers and a high number of positive ENA antibodies serve as key reference indicators for diagnosis.Among speckled nuclear patterns,dsDNA is the most prevalent ENA.