两种方法联合检测风湿性疾病中ANCA的临床意义

The clinical significance of ANCA in rheumatic diseases detected by the combination of Immunoflourescence technique and ELISA

目的评价间接免疫荧光法(IIF)和酶联免疫吸附试脸(ELISA)检测抗中性粒细胞胞浆抗体(ANCA)的临床意义。方法采用IIF和ELISA方法联合对120例风湿性疾病患者的血清进行ANCA检测。结果在120例检验标本中C-ANCA阳性与PR3-ANCA阳性是一一对应的;而在37例SLE患者中,有7例P-ANCA阳性,1例a-ANCA阳性,1例C-ANCA阳性,MPO-ANCA阳性者6例,PR3-ANCA阳性者1例;在31例RA中4例P-ANCA阳性,而5例MPO-ANCA阳性。结论IIF法一般情况下可作为临床常规检测ANCA的筛选试验,ELISA法可作为特异ANCA确证试验,但在血管炎中ELISA方法是必须的,仅靠IIF法有可能引起ANCA的漏检。二者联合应用可以提高ANCA的检出率,减少ANCA的误诊率。

Objective To evaluate the clinical significance of the combination of technique （IIF） and ELISA in detecting anti neutrophil cytoplasmic antibodies（ANCA）. Methods ANCA fluorescent patterns and its target antigens in sera of 120 patients with rheumatic disease were detected by IIF and ELISA. Results C-ANCA detected by IIF is nearly always directed against PR3-ANCA in the sera of the 120 patients,whereas in the 37 patients with SLE, P-ANCA, a-ANCA and MPO-ANCA have 7,1 and 6 cases positive respectively, in the 31 patients with RA,P-ANCA and MPO-ANCA have 4 and 5 cases positive respectively. Conclusion the method of IIF under normal circumstances could be used for testing ANCA in clinical routine screening test, the method of ELISA can be used as specific ANCA confmnatory test. But ELISA is mandatory when vasculitis is present, ANCA is likely to be missed if ANCA is detected only by the method of IIF. Combination of the two methods can increase the detection rate and reduce the misdiagnosis rate of ANCA