抗中性粒细胞胞浆抗体阳性患者疾病谱分析

Spectrum of disease in patients with positive antineutrophil cytoplasmic antibodies in general hospitals

目的探讨抗中性粒细胞胞浆抗体（ANCA）对诊断血管炎或其他疾病的临床意义。方法从北京大学人民医院2005年1月至2008年9月间ELISA方法检测ANCA阳性的患者中随机抽取104例，对其临床特点及诊断作回顾性分析。结果104例中血管炎患者22例（21．2％），其中确诊原发性ANCA相关性小血管炎13例。非血管炎患者82例（78．8％），其中结缔组织病40例，包括系统性红斑狼疮、类风湿关节炎；非结缔组织病42例，其中以溃疡性结肠炎最为常见。根据ELISA方法检测的ANCA结果，分为蛋白酶3（PR3）-ANCA阳性组及髓过氧化物酶（MPO）-ANCA阳性组，与PR3组对比，MPO组患者的受累系统更多且肾脏受累更常见（P〈0．01），而胃肠道受累较少见（P〈0．01）。与非血管炎组对比，血管炎组受累系统更多（2．28比3．55，P〈0．01），上呼吸道、下呼吸道及肾脏受累更常见（P〈0．叭或〈0．05）；白细胞总数升高、24h红细胞沉降率增快在血管炎组发生率更高（分别为P〈0．01，P〈0．05）。结合受累系统数、临床表现及实验室检查可提高对血管炎的阳性预测值。结论ANCA阳性患者的疾病谱很广，结合临床特点及实验室检查综合分析，可以提高ANCA对于系统性血管炎的诊断意义。

Objective To investigate clinical significance of positive antineutrophil cytoplasmic antibodies （ANCA） in diagnosis for vasculitis or other diseases. Methods From January 2005 to December 2008, 104 patients with positive ANCA detected by enzyme-linked immunosorbent assay （ELISA） in People＇s Hospital of Peking University were randomly selected and their clinical features and diagnoses were analyzed retrospectively. Results Among 104 ANCA-positive patients, 22 were diagnosed as vasculitis and 13 as ANCA-associated vascnlitis, and 82 （78.8%）were diagnosed as non-vasculitis including 40 of connective diseases such as systematic lupus erythematosus （SLE） and rheumatoid arthritis （RA） and 42 of non-connective diseases with the most common of ulcerative colitis. According to the results of ANCA tests by ELISA, ANCA-positive patients could be divided into those with proteinase 3 （PR3）-positive and myeloperoxidease （MPO）-positive. More organs were involved in MPO-positive patients （n = 48） than that in PR3-positive ones （ n = 49） , and more frequent involvement of the kidneys and less frequent involvement of the gastrointestinal tract in MPO-positive than those in PR3-positive ones （P 〈 0. 01）. As compared to those with non-vasculitis, more organs （2. 28 organs vs. 3.55 organs in average） were involved in patients with vasculitis （P 〈0. 01 ） and more frequent involvement of the upper or lower respiratory tracts and the kidneys in vasculitis patients （P 〈 0. 01 or 〈 0.05, respectively）. Elevated leukocyte count and accelerated erythrocyte sedimentation rate （ESR） were also more common in vasculitis patients than those in nonvasculitis ones （P 〈 0. 01 and P 〈 0. 05, respectively）. Positive ANCA combined with number of organs involved, clinical manifestations and other laboratory findings, its positive predictive value （PPV） in diagnosis for vasculitis can be improved. Conclusions Spectrum of disease in patients with positive ANCA was varied. Diagnostic value of positive ANCA in diagnosis for vasculitis can be improved if combined with comprehensive analysis of their clinical features and laboratory examinations.