抗中性粒细胞胞浆抗体及其靶抗原检测与肾脏疾病的临床研究

Study on correlation between Antineutrophilic cytoplasmic antibodies and renal diseases

目的 评价抗中性粒细胞胞浆抗体 (ANCA)与肾脏疾病关联及其诊断、随访价值 ,初步探讨不典型ANCA(A ANCA)的临床意义。方法 以IIF法、ELISA法联合检测ANCA及其靶抗原。结果 2 7例ANCA阳性 :16例原发性系统性血管炎 (4例C ANCA+ /PR3 ANCA+ ,7例P ANCA+ /MPO ANCA+ ,4例P ANCA+ /抗原不明 ,1例C ANCA+ /抗原不明 ) ,2例紫癜肾 (P ANCA+ /抗原不明 ) ,3例SLE(P ANCA+ /LF ANCA+ ) ,此外A ANCA6例。结论 PR3 ANCA、MPO ANCA为原发性系统性血管炎重要诊断、分型和随访指标 ,LF ANCA与SLE肾脏损害无关联 ,A ANCA检出于自身免疫性疾病 ,较多肝。

Objective To evaluate the correlation between anti neutrophilic cytoplasmic antibodies (ANCAs) and renal diseases, and its significance in diagnosis and follow up study. Methods ANCAs and the specific antigens were detected by indirect immunofluorescence (IIF) combined with ELISA. Results 27 cases presented positive ANCAs, including 16 primary systemic vasculitis (4 with C ANCA +/PR3 ANCA +, 7 with P ANCA +/MPO ANCA +, 4 with P ANCA + and 1 with C CNCA + but antigens unknown), 2 HSP nephritis (P ANCA + but antigens unknown), 3 LN (P ANCA +/LF ANCA +), and 6 atypical ANCA + cases in MCTD, RA, SS, etc.Conclusion The value of IIF ANCA can be greatly increased by the addition of antigen specific ELISA. ANCA should be the most important diagnostic marker of WG and MPA, as well as the reference marker in follow up. Its titer is in concordance with disease activity, while the effect of LF ANCA is unknown yet. As detected in other connective tissue diseases, atypical ANCA may participate in immune modulation also as an autoimmune antibody.(Shanghai Med J, 2001,24∶71 74)