ANCA水平检测在SLE活动期和SLE引起的新月体肾炎中的临床意义

Clinical Significance of ANCA Level Detection in the Active Stage of SLE and SLE-induced Crescentic Glomerulonephritis

目的探讨抗中性粒细胞胞质抗体(ANCA)在系统性红斑狼疮(SLE)活动期和在SLE特殊临床症状如SLE引起的新月体肾炎(CGN)中的临床意义。方法采用间接免疫荧光法(IIF)和免疫印迹法(Western blot)测定126例SLE患者的ANCA和与SLE活动性及SLE引起的CGN密切相关的特异性自身抗体:抗双链DNA(ds-DNA)抗体、抗核小体(AnuA)抗体和抗组蛋白(His)抗体,用ELISA法检测验证ANCA阳性率,用SLE活动指数(SLEDAI)判断SLE活动性,用肾组织病理学检查了解由SLE引起的CGN的发生情况,分析ANCA、SLEDAI和特定自身抗体间的关系。结果在126例SLE患者中IIF法检测ANCA的阳性率为31.7%(40/126),且均为PANCA。用ELISA法验证全部ANCA阳性患者血清,阳性率为77.5%(31/40),且均为髓过氧化物酶(MPO)即为PANCA。ANCA阳性组SLEDAI评分>10分者(即SLE活动期)占71.0%与ANCA阴性组(39.5%)相比差异有显著性意义(P<0.01)。ANCA阳性率与抗ds-DNA抗体、抗AnuA抗体和抗His抗体的阳性率呈正相关。ANCA阳性的40例SLE患者32例有肾损害,病理切片显示为CGN的有21例,即ANCA阳性组CGN患者的比例为52.5%,明显高于阴性组CGN的18.6%(P<0.01)。结论ANCA对诊断SLE活动性有一定的临床意义,并可用于对SLE引起的CGN的预测。

Objective To explore the clinical significance of antineutrophil cytoplasmic antibody（ANCA） detection in the diagnosis of active stage of systemic lupus erythematosus（SLE） and SLE-induced crescentic glomerulonephritis（CGN）.Methods ANCA and specific autoantibodies,including anti-ds DNA antibody,anti-nucleosome（AnuA） antibody and anti-histone（his） antibody,in 126 SLE patients were detected by indirect immunofluorescence（IIF） and Western blot.The positive rate of ANCA was detected by ELISA.The occurrence of SLE-induced CGN was observed by nephridial tissue pathological detection.The relationship between SLE disease activity index（SLEDAI）,ANCA and the specific autoantibodies was analyzed.Results In 126 SLE patients,the positive rate of ANCA detected by IIF was 31.7%,which were all PANCA.In ANCA positive patients,the serum positive rate of ANCA confirmed by ELISA was still 77.5%,which were all myeloperoxidase（MPO） positive,namely PANCA.In ANCA positive group,the percentage of SLEDAI score more than 10 was 70.9%,which was significantly higher than in ANCA negative group（39.5%,P〈0.05）.The ANCA positive rate had a positive correlation with the positive rates of anti-ds DNA antibody,AnuA antibody and his antibody.In 40 SLE patients positive for ANCA,32 had the kidney damage,and 21 patients（52.5%） were pathologically diagnosed as CGN.In 86 patients negative for ANCA,16 patients（18.6%） were suffered from CGN.The CGN incidence in ANCA positive group was obviously higher than that in ANCA negative group（P〈0.01）.Conclusion ANCA has certain clinical significance in the diagnosis of lupus activity and has certain clinical predictability in the occurrence of SLE-induced CGN.