抗中性粒细胞胞浆抗体在系统性红斑狼疮伴有血管炎病变中的临床意义

Study on the relationship between antineutrophil cytoplasmic antibodies and vasculitis in Systemic Lupus Erythematosis

目的探讨抗中性粒细胞胞浆抗体(ANCA)在系统性红斑狼疮(SLE)伴有血管炎病变中的临床意义。方法收集138例SLE住院病例的临床和实验室资料,间接免疫荧光(IIF)方法检测患者血清AN-CA,ANCA阳性者加做髓过氧物酶(MPO)、蛋白酶3(PR3)的酶联免疫检测(ELISA)。对患者进行SLEDAI评分评判疾病活动性,比较间接免疫荧光法检测ANCA阳性组与阴性组血管炎病变发生比率及疾病活动度有无差异。结果①间接免疫荧光法检测ANCA在SLE中的阳性率是15.2%,其中核周型ANCA阳性14.5%,胞浆型ANCA阳性0.7%;②SLE患者皮肤血管炎病变(包括面部红斑、结节红斑、雷诺现象、网状青斑、紫癜)发生率78.3%,肺间质病变(包括肺间质纤维化及出血性肺泡炎)发生率6.5%,肾脏病变(血尿及蛋白尿)发生率64.5%,ANCA阳性及ANCA阴性组SLE患者血管炎表现,包括皮肤血管炎(P=0.442)、肺间质病变(P=1.000)、肾脏病变(P=0.471)差异无统计学意义。③对所有SLE患者进行SLEDAI评分,ANCA阳性组及ANCA阴性组SLE活动性差异无统计学意义(P=0.879)。结论采用间接免疫荧光法检测ANCA的结果与SLE血管炎表现及病情活动无明显相关性。

Objective To investigate the clinical significance of antineutrophil cytoplasmic antibodies （ANCA ） in vasculitis in Systemic Lupus Erythematosis （SLE）. Methods 138 SLE patients＇ clinical manifestations （including laboratory indexes） were collected, ANCA was detected by indirect immunofluorescence （IIF） , and the positive ones were detected MPO and PR3 by ELtSA. We accessed the disease activity as measured by SLEDAI and compared the SLE vasculitis clinical manifestations and disease activity between IIF-ANCA-positive and negative patients. Results （1） As detected by IIF technique, ANCA were present in 15.2 % of SLE patients, and 14.5% of them were peripheral nuclear ANCA. （2） Cutaneous vasculitis was found in 78.3% of patients with SLE ,nephritis 64.5% ,interstitial lung disease 6.5%. No association was found between IIF-ANCA and any of the vaseulitis clinical manifestation at the time of assessment （ cutaneous vasculitis ： P = 0. 442, interstitial lung disease： P = 1. 000 ）, nephritis ： P = 0.472. （3） No statisti- cally significant difference was found to be existed between SLEDAI of IIF-ANCA positive and negative patients （ P = 0.8790）. Conclusion No correlation between IIF-ANCA and vasculitis in SLE or acitivitv of SLE.