抗中性粒细胞胞质抗体 抗髓过氧化物酶 抗蛋白酶3在系统性血管炎和其他自身免疫病中的临床意义

The clinical significance of antineutrophil cytoplasmic antibodies,anti-myeloperoxidase antibodies and antiproteinase 3 antibodies in systemic vasculitis and other autoimmune diseases

目的探讨抗中性粒细胞胞质抗体(ANCA)、抗髓过氧化物酶(MPO)、抗蛋白酶3(PR3)在系统性血管炎和其他自身免疫病患者中的阳性率及其临床检测中的意义。方法采用酶联免疫吸附试验(ELISA)法检测抗MPO抗体和抗PR3抗体,间接免疫荧光技术(IIF)法检测ANCA。结果系统性血管炎患者ACNA阳性率为46.25%,抗PR3和抗MPO抗体阳性率分别为28.25%和12.00%;自身免疫病患者ACNA阳性率为9.86%,抗PR3和抗MPO抗体阳性率分别为1.25%和2.42%。系统性血管炎患者ANCA检出率显著高于自身免疫病患者(χ~2=257.99,P<0.05),系统性血管炎与自身免疫病抗MPO抗体和抗PR3阳性率差异具有统计学意义(抗MPO抗体χ~2=58.85,P<0.05);抗PR3抗体(χ~2=296.13,P<0.05)。结论 ANCA、抗PR3抗体和抗MPO抗体与系统性血管炎密切相关,抗PR3抗体主要与韦格纳肉芽肿病(WG)相关,抗MPO抗体主要与显微镜下多血管炎、结节性多动脉炎、变应性肉芽肿性血管炎相关,ANCA、抗PR3和抗MPO抗体可作为系统性血管炎与自身免疫病诊断和鉴别诊断的重要标志物。

Objective To investigate the positive rate and clinical significance of antineutrophil cytoplasmic antibodies （ANCA）, anti-myeloperoxidase antibodies （anti-MPO） and anti-proteinase 3 antibodies （anti-PR3） antibodies in systemic vasculitis and other autoimmune diseases. Methods Enzyme linked immunosorbent assay （ELISA） was used to detect the anti-MPO and anti-PR3 antibodies-Indirect immunofluorescence （IIF） was used to detect the ACNA. Results The positive rate of ANCA,anti-PR3 and anti-MPO antibodies in patients with systemic vasculitis was 46.25%, 28.25% and 12.00%;while in patients with other autoimmune diseases was 9.86%, 1.25% and 2.42%. The positive rate of ANCA in patients with systemic vasculitis was significantly higher than in patients with other autoimmune diseases （ x2=257.99, P〈0.05）.The positive rate of anti-MPO and anti-PR3 antibodies was statistically different between in patients with systemic vasculitis and in patients with other autoimmune diseases （anti-MPO antibodies x2 =58.85, P〈0.05; anti-PR3 antibodies Xz=296.13, P〈0.05）. Conclusion ANCA,anti-PR3 and anti-MPO antibodies were closely associated with systemic vasculitis; Anti-PR3 antibodies primarily associated with Wegener＇s granulomatosis （WG） while anti-MPO antibodies primarily associated with MPA, PAN, CSS, ANCA, anti-PR3 and anti-MPO antibodies could be used as markers of diagnosis and differential diagnosis between patients with systemic vascnlitis and patients with other autoimmune diseases.