联合使用间接免疫荧光法和酶联免疫吸附法检测抗中性粒细胞胞质抗体结果不一致589例临床分析

Clinical analysis of the inconsistency of antineutrophil cytoplasmic antibodies test results between indirect immune fluorescence and enzyme-linked immunosorbent assay in 589 cases

目的 分析间接免疫荧光法（IIF）和ELISA联合检测ANCA结果不一致的患者临床特点及其临床意义.方法 采用IIF和ELISA同时检测12 386例住院患者的ANCA,并运用Microsoft Excel 2007统计软件对2种方法结果不一致的589例的临床特点进行了回顾性分析.结果 589例患者中血管炎患者68例（11.5％）,其中确诊为原发性ANCA相关性小血管炎者51例;在非血管炎患者的521例（88.4％）中,确诊为CTD 181例,非CTD 340例.非CTD中以高血压和心脏病最为常见.589例患者中,ANCA不一致可分为3类9种表型,其中以第1类IIF（＋）/ELISA（-）中的核周型（p）-ANCA/ELISA（-）（24.4％,144/589）和第3类IIF（-）/ELISA（＋）中的IIF（-）/抗MPO抗体（＋）（29.5％,174/589）、IIF（-）/抗PR3抗体（＋）（15.9％,94/589）、IIF（-）/抗PR3抗体（＋）抗MPO抗体（＋）（18.5％,109/589）为多见不一致表型,占总不一致表型的88.3％（520/589）.结论 联合IIF和ELISA检测ANCA结果不一致的患者疾病谱较广;临床表现和首发症状均具多样性特征;常涉及多器官受累,容易造成漏诊、误诊,临床上需注意识别并提高诊断和鉴别诊断能力.

Objective To analyze the clinical significance and features of patient s＆#39; with inconsistent antineutrophil cytoplasmic antibodies （ANCA） test results between indirect immune fluorescence （IIF） and enzyme-linked immunosorbent assay （ELISA）.Methods ANCA were detected with IIF and ELISA method jointly among 12 386 in-patients and a retrospective analysis on the proportion of clinical features and significance was made in 589 cases with inconsistent results using Microsoft Excel 2007 statistical software.Results Among the 589 patients,68 （11.5%） were diagnosed as vasculitis,in which 51 cases as ANCA-associated vasculitis,and 521（88.4%） were diagnosed as non-vasculitis including 181 connective disease and 340 non-connective diseases in which hypertension and cardiopathy were common.The common inconsistent results of ANCA were p-ANCA/ELISA （-）,IIF （-）/anti-MPO （＋）,IIF （-）/anti-PR3 （＋）,IIF （-）/anti-PR3 （＋） anti-MPO （＋） accounted for 24.4% （144/589）,29.5% （174/589）,15.9% （94/589）,18.5% （108/589） respectively,these accounted for 88.3%（520/589） of total inconsistency.Conclusion The spectrum of diseases and clinical characteristics varies widely and often presents with multiorgan involvement in patients with inconsistent ANCA results.These reasons make it easy to be misdiagnosed.Attention should be paid to identify and different these inconsistency.