ANCA与SLE临床表现的相关性及其意义

Anti-neutrophil Cytoplasmic Antibodies in Systemic Lupus Erythematosus

目的:探讨系统性红斑狼疮(Systemic Lupus Erythematosus,SLE)患者抗中性粒细胞胞浆抗体(Anti-neutrophil Cytoplasmic Antibodies,ANCA)与肾炎及其他临床表现和实验室检查的相关性及其意义。方法:采用前瞻性研究收集77例系统性红斑狼疮患者,用间接免疫荧光法(IIF)检测患者血清ANCA、ELISA法检测ANCA抗原,检测其他免疫学指标如抗核抗体、抗dsDNA抗体等。结果:77例SLE患者中ANCA阳性28(36.4%)例,ANCA阳性组浆膜炎、肾损害、神经精神症状、皮肤血管炎、抗dsDNA抗体阳性、抗Sm抗体阳性、补体下降以及血清IgG升高的发生率明显高于阴性组(P<0.05)。52例LN患者中,25例(48.1%)ANCA阳性,其中P-ANCA阳性者22例(88%),3例(12%)为a-ANCA均出现在RPGN,无一例出现c-ANCA。非LN组25例患者中,仅3例(12%)p-ANCA阳性,且均为抗-MPO。正常对照组无一例ANCA阳性。77例SLE患者中,14例(18.2%)为抗-MPO;13例(16.9%)为抗LF,且只见于DPGN、FPGN和RPGN伴有新月体形成者;10例(13%)为抗-CG,但在非狼疮肾炎患者未检测到抗-LF及抗-CG。在各种临床表现中,抗-MPO与肾脏和皮肤表现有关;而抗-LF与肾脏、关节炎及浆膜炎有关;抗-CG可见于各种临床表现。结论:ANCA可作为评价SLE疾病及鉴别血管炎和狼疮肾炎的一个重要指标。

Objective： To investigate the prevalence of ANCA in patients with Systemic Lupus Erythematosus（SLE） to find the association between ANCA and renal lesion and other clinical manifestations. Methods： The prospective study of 77 patients with SLE was used. Indirect immunofluorescenee （IIF） and ELISA were used to detect the ANCA and its target antigen. Results： 28 cases of 77 patients with SLE were ANCA positive. There are significant differences in the clinical features including serositis, nephropathy, neural disorder, cutaneous vasculitis as well as in laboratory results including Anti-dsDNA,Anti-Sm,higher serum IgG and lower levels of C3/C4 between SLE with ANCA positive group and negative group. In 52 patients with LN, 25（48.1%） was ANCA positive; between them, 22（88 %） were p-ANCA positive, and 3（12 %） were a-ANCA positive and all were RPGN, none was c-ANCA positive. 3（12 %） of 25 non-LN were ANCA positive and all were anti-MPO. There was no ANCA positive in normal control. Among 77 cases with SLE, there were 14cases（18.2 %） were anti-myeloperoxidase（anti-MPO）; 13 cases（16.9 %） were anti-lactoferrin （anti-LF） and seen only in DPGN、FPGN and RPGN with crescents; 10 cases（13 %） were anti-cathepsin G（anti-CG）. Anti-LF and anti-CG were not detected in non-LN patients. It was observed that anti-MPO was associated with renal and skin manifestation, while anti-LF was seen in renal and joint involvement and serositis. Patients having only anit-CG had a varied clinical presentation. Conclusion： ANCA in SLE may be used as a serological marker along with clinical and histopathological assessment to differentiate vasculitides in LN cases from SLE without nephritis.