抗中性粒细胞胞浆抗体在狼疮性肾炎患者中的临床意义

Clinical significance of antineutrophil cytoplasmic antibodies in patients with lupus nephritis

目的分析抗中性粒细胞胞浆抗体(ANCA)阳性的狼疮性肾炎(LN)患者的临床特点,探讨ANCA检测的临床意义。方法选择261例LN患者,使用ELISA法将其分为ANCA阳性和ANCA阴性两组,分别为53例和208例。回顾性分析所有患者的一般情况、诊断标准数、狼疮活动度(SLE-DAI)评分、症状、体征、并发症和各种常规、生化、免疫学检查以及病理结果、随访结果。结果ANCA阳性组中浆膜炎(75.5%)、急性肾衰(64.2%)、心肌炎(30.2%)、神经精神症状(26.4%)、肺出血(7.5%)明显高于ANCA阴性组(P<0.05);同时ANCA阳性组与阴性组比较,在SLE-DAI评分、诊断标准数、血沉、血红蛋白(≤11g/dl)、抗Sm、补体C3、γ球蛋白、IgG方面差别有统计学意义(P<0.05);ANCA阳性组中病理以Ⅳ型LN(67.9%)为主,慢性指数(CI)、新月体形成、肾小管萎缩、微血栓与ANCA阴性组比较有统计学意义(P<0.05);预后方面ANCA阳性组死亡率高于ANCA阴性组(P<0.05)。结论ANCA的定性分析有助于判断LN患者病情活动程度及预后。

Objective To analyze the clinical features of patients with lupus nephritis positive for antineutrophil cytoplasmic antibodies （ANCA） and explore the clinical implications of ANCA detection. Methods Totally 261 patients with lupus nephritis were enrolled in this study, including 53 ANCA-positive and 208 ANCA-negative ones. The clinical data of the patients pertaining to the disease history, physical examination, laboratory examinations and pathological inspection were retrospectively analyzed. Results Compared with patients negative for ANCA, the ANCA-positive patients had significantly higher incidence of serositis （75.5%）, acute renal failure （64.2%）, myocarditis （30.2%）, neuropsychiatric involvement （26.4%） and lung homorrhage （7.5%）（P〈0.05）. Significant differences were also found between the two groups in SLE disease active index （SLE-DAI）, number of the diagnostic criteria, erythrocyte sedimentation rate （ESR）, anemia, anti-Sm antibodies, and serum complement C3. Most patients positive for ANCA （67.9%） had type Ⅳ lupus nephritis with more crescent formation, renal tubular atrophy, hyaline thrombi, and higher mortality rate as well than the negative patients. Conclusion ANCA detection may benefit the estimation of the disease severity and prognostic evaluation of lupus nephritis.