Altintas Abdullah, Ozel Abdulkadir, Okur Nilufer, Okur Nurettin, Cil Timucin, Pasa Semir, Ayyildiz Orhan
Department of Hematology-Oncology, Internal Medicine, Dicle University, 21280 Diyarbakir, Turkey.
J Thromb Thrombolysis. 2007 Oct;24(2):163-8. doi: 10.1007/s11239-007-0031-y. Epub 2007 Apr 14.
To determine the clinical significance of the antinuclear antibody (ANA) test in children and adult patients with idiopathic thrombocytopenic purpura (ITP).
We conducted a retrospective analysis of 365 children and 108 adult patients with ITP. Patients found to have positive ANA were regularly followed-up by an experienced hematologist until December 2006 for development of symptoms indicative of autoimmune disorder. Mean follow-up 3.6 years (range: 2.1-7 years) for all patients. At the time of diagnosis of ITP, patients with connective tissue diseases (CTD) were excluded. Out of 365 childhood ITP; 301 (82.4%) patients were acute, 64 (17.6%) patients were chronic ITP. ANA titer > or = 1:80 were positive in 33 (9.04%) of 365 patients with childhood ITP; 21 patients (6.9%) were in acute, and 12 patients (18.7%) were in chronic group. Out of 108 adult patients with ITP; 31 (28.7%) patients were acute and 77 (71.3%) patients were chronic ITP cases. ANA titer > or = 1:80 were positive in 36 (33.3%) of 108 patients with adult ITP; 12 patients (38.8%) were in acute, and 24 patients (31.2%) were in chronic group. At the end of follow-up period Sjogren's syndrome (SS) was diagnosed in only one adult chronic ITP cases. None of the other ANA positive patients developed SLE or other CTD.
Our data demonstrated that ANA positivity is often found in adult and children patients with ITP, and indicate that the detection of ANA positivity is not enough to identify those patients with ITP who are at risk of developing SLE or other CTD. There is a statistically significant difference in terms of ANA positivity between childhood acute and chronic ITP patients. We think that ANA positivity may be an indicator in terms of chronicity for childhood ITP. However, large-scale studies should be considered to determine the significance of ANA positivity and their utility in differentiating acute from chronic ITP.
确定抗核抗体（ANA）检测在儿童和成人特发性血小板减少性紫癜（ITP）患者中的临床意义。
我们对365例儿童和108例成人ITP患者进行了回顾性分析。发现ANA阳性的患者由经验丰富的血液科医生定期随访至2006年12月，以观察是否出现自身免疫性疾病的症状。所有患者的平均随访时间为3.6年（范围：2.1 - 7年）。在ITP诊断时，排除患有结缔组织病（CTD）的患者。在365例儿童ITP患者中；301例（82.4%）为急性患者，64例（17.6%）为慢性ITP患者。365例儿童ITP患者中33例（9.04%）ANA滴度≥1:80呈阳性；急性组21例（6.9%），慢性组12例（18.7%）。在108例成人ITP患者中；31例（28.7%）为急性患者，77例（71.3%）为慢性ITP患者。108例成人ITP患者中36例（3 .3%）ANA滴度≥1:80呈阳性；急性组12例（38.8%），慢性组24例（31.2%）。随访期末仅1例成人慢性ITP患者被诊断为干燥综合征（SS）。其他ANA阳性患者均未发生系统性红斑狼疮（SLE）或其他CTD。
我们的数据表明，成人和儿童ITP患者中常发现ANA阳性，且提示ANA阳性检测不足以识别有发生SLE或其他CTD风险的ITP患者。儿童急性和慢性ITP患者在ANA阳性方面存在统计学显著差异。我们认为ANA阳性可能是儿童ITP慢性化的一个指标。然而，应考虑进行大规模研究以确定ANA阳性的意义及其在鉴别急性与慢性ITP中的作用。
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