ANCA阴性少免疫沉积型新月体性肾炎患者血清AECA与临床表现的关系研究

Relationship between serum AECA and clinical signatures of ANCA negative pauci-immune deposition type crescentic glomerulonephritis patients

目的:探讨抗中性粒细胞胞浆抗体(ANCA)阴性少免疫沉积型新月体性肾炎患者血清抗内皮细胞抗体(AECA)表达情况,及其与临床表现的关系。方法:选取2010年至2015年在我院治疗的少免疫沉积型新月体性肾小球肾炎患者,其中ANCA阴性患者45例(观察组),ANCA阳性患者49例(对照组),采用Western blot检测各组患者血清AECA水平。结果:观察组平均年龄和伯明翰血管炎活动性评分(BVAS)分别为(41.08±9.43)岁和(15.03±3.82)分,明显低于对照组(P<0.05);观察组出现发热、关节痛的比例分别为26.67%和13.33%,明显低于对照组(P<0.05);观察组出现肾病综合征比例为48.89%,高于对照组(P<0.05);观察组血清AECA阳性率为46.67%,明显低于对照组的81.63%(P<0.05);观察组Ig G-AECA共识别7种蛋白,而对照组共识别11种蛋白,其中观察组抗90 k D抗体阳性率为13.33%(6/45),明显低于对照组的51.02%(25/49)(P<0.05);观察组抗76 k D抗体阳性患者出现皮疹的比例为100%,明显高于阴性患者(P<0.05),抗200 k D抗体阳性患者BVAS评分为(18.02±2.51)分,明显高于阴性患者(P<0.05)。结论:ANCA阴性少免疫沉积型新月体性肾炎患者血清存在不同的AECA,可能与某些临床表现有关;ANCA阴性和阳性患者AECA有所不同,两者临床表现的差异可能与AECA的不同有关,需待进一步研究。

Objective：To investigate the expression of anti-endothelial cell antibodies（AECA） in patients serum with anti-neutrophil cytoplasmic antibody（ ANCA） negative pauci-immune deposition type crescentic glomerulonephritis and its relationship with clinical signatures. Methods：We selected 94 pauci-immune deposition type crescentic glomerulonephritis patients from 2010 to 2015 treated in our hospital,45 of which with ANCA-negative（ observation group） and 49 cases of ANCA-positive patients （ control group） , AECA levels of each groups serum were detected by Western blot test. Results： The average age of the observation group and Bermingham vasculitis activity score（BVAS） respectively （41. 08 ＋9. 43） years old and （15. 03 ＋3. 82）,significantly lower than the control group （P〈0. 05）;the observation group had fever,joint pain accounted for 26. 67% and 13. 33%,significantly lower than the control group （ P〈0. 05 ）;the observation group of nephrotic syndrome accounted for 48. 89%, higher than the control group （ P〈0. 05）;observation group positive rate of serum AECA was 46. 67%,significantly lower than the control group 81. 63% （P〈0. 05）;the observation group IgG-AECA identified 7 proteins,while the control group had identified 11 proteins,of which the observation group the positive rate of anti 90 kD antibody was 13. 33%（ 6/45 ） , significantly lower than the control group 51. 02%（ 25/49 ） （ P〈0. 05 ）;observation group of anti 76 kD antibody positive patients had rash ratio of 100%, significantly higher than negative patients （ P〈0. 05）,anti 200 kD antibody positive the BVAS score of the patients was （18. 02 ＋ 2. 51）,which was significantly higher than that of the negative patients （ P 〈 0. 05 ） . Conclusion： The different level of AECA in ANCA negative pauci-immune crescentic glomerulonephritis patients may be associated with certain clinical manifestations;clinical manifestations differences between the ANCA negative and positive patients may be associated with different expression of the AECA related,the detail need a further study.