两种方法联合检测自身免疫性疾病中ANCA的临床意义

The clinical significance of ANCA in autoimmune diseases detected by the combination of immunoflourescence technique and western blotting test

目的评价间接免疫荧光法(IIF)和免疫印迹法检测抗中性粒细胞胞质抗体(ANCA)的临床意义。方法采用IIF和免疫印迹法联合对126例自身免疫性疾病患者的血清进行ANCA检测。结果在126例患者中类风湿关节炎(RA)、韦格纳肉芽肿瘤(WG)、皮肌炎(DM)和过敏性紫癜患者血清检测cANCA阳性与PR3-ANCA阳性是一一对应的;而在51例SLE患者中,有17例(33.3%)pANCA阳性,7例(13.7%)骨髓过氧化物酶(MPO)-ANCA阳性;在29例RA中3例(10.3%)pANCA阳性,而4例(13.7%)MPO-ANCA阳性。WG和ANCA相关性血管炎患者检测ANCA阳性率较高,分别为87.5%和93.7%。结论IIF一般情况下可以作为临床常规检测ANCA的筛选试验,免疫印迹法可以作为特异ANCA确证试验。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 by combining immunoflourescence technique（IIF）and Western blotting tests in detecting anti neutrophil cytoplasmic antibodies（ANCA）.Methods ANCA fluorescent patterns and its target antigens in sera of 126patients with autoimmune disease were detected by IIF and Western blotting test.Results cANCA detected by IIF was nearly always directed against PR3-ANCA in the sera of the126patients,whereas among 51patients with SLE,17samples were positive for pANCA,7samples were positive for MPO-ANCA.Among 29patients with RA,3samples were positive for pANCA and 4samples were positive for MPO-ANCA.In the patients of WG and ANCA associated vasculitis,the positive rates of ANCA were 87.5%and 93.7%respectively.Conclusion The method of IIF under normal circumstances could be used for testing ANCA in clinical routine screening test,and the method of Western blotting test can be used as specific ANCA confirmatory test.Combination of the two tests can increase the detection rate and reduce the misdiagnosis rate of ANCA.