各种抗中性粒细胞胞浆抗体在微型多动脉炎诊断中的意义

Detection of antibodies to different neutrophil cytoplasm antigens in microscopic polyangiitis

目的：进一步阐明不同抗原抗中性粒细胞胞浆抗体（ＡＮＣＡ）在微型多动脉炎（ＭＰＡ）诊断中的意义。方法：首次在国内对３９例ＭＰＡ患者进行了间接免疫荧光（ＩＩＦ）┐ＡＮＣＡ，髓过氧化物酶（ＭＰＯ）┐ＡＮＣＡ，细菌渗透增强蛋白（ＢＰＩ）┐ＡＮＣＡ和蛋白酶３（ＰＲ３）┐ＡＮＣＡ检测，并结合临床和病理特点进行了分析。结果：３９例中ＡＮＣＡ阳性者２５例（６４．１０％），其中ＩＩＦ┐ＡＮＣＡ阳性率为１７．９５％，ＭＰＯ┐ＡＮＣＡ为３８．４６％，ＢＰＩ┐ＡＮＣＡ为２０．５１％，ＰＲ３┐ＡＮＣＡ为７．６９％，各种ＡＮＣＡ试验可单独阳性，也可合并存在，以ＭＰＯ┐ＡＮＣＡ的合并存在率最高。结论：ＡＮＣＡ在ＭＰＡ诊断中具有肯定意义，不仅是ＭＰＡ诊断的一个血清学标志，而且是疾病活动和进展的标志之一。从临床实际出发同时检测ＭＰＯ┐ＡＮＣＡ、ＢＰＩ┐ＡＮＣＡ。

BACKGROUND Anti neutrophil cytoplasmic antibodies(ANCAs) have been linked with systemic vasculitides and various kind of connective tissue diseases, but the significance of different ANCAs has not yet been extensively studied in microscopic polyangiitis(MPA). To elucidate the significance of antibodies to different neutrophil cytoplasm antigens in the diagnosis of MPA,a retrospective analysis was made in 39 patients with MPA in the present study. METHODS 〖WTBZ]IIF ANCA was detected by indirect immunoflurence assay, MPO ANCA (anti myeloperoxidase), BPI ANCA (anti bactericidal/permeability increasing protein) and PR3 ANCA(anti proteinase 3) were measured by ELISA. Clinical and renal pathological data were analyzed with regard to the different patterns of these autoantibodies. RESULTS 〖WTBZ] Patients positive for any one of the ANCAs accounted for 64.10% in this group of MPA patients. The percentages of patients with positive IIF ANCA,MPO ANCA,BPI ANCA and PR3 ANCA were 17.95%,38.46%, 20.51% and 7.69% respectively. The most frequent ANCAs in patients with MPA was MPO ANCA. No patient was found positive for very of the four ANCAs. The percentages of patients positive for three ANCAs, two ANCAs and one ANCA were 2.56%, 15.38%, 46.15% respectively. Rapidly progressive glomerulonephritis syndrome and arthropathy were more frequent in ANCA positive patients, as compared with ANCA negative patients ( P <0.05, P <0.01). No significant difference was found in the clinical and renal pathological manifestations among patients with different patterns of ANCAs, although different patterns of ANCAs were related to different clinical and histopathology features. CONCLUSION 〖WTBZ] ANCAs are not only diagnostic parameters for MPA, but also a marker of disease activity. MPO ANCA,BPI ANCA and IIF ANCA should be detected simultaneously for the diagnosis of MPA