增殖型狼疮性肾炎患者血清中性粒细胞胞浆抗体阳性的临床意义

The clinical significance of ANCA positive serology in patients with proliferative lupus nephritis

目的分析中性粒细胞胞浆抗体(ANCA)阳性的增殖型狼疮性肾炎(PLN,即WHO分类中的III和IV型)患者的临床及病理特点,探究ANCA在PLN病理过程中的可能意义。方法 54例肾穿活检证实为PLN患者,据血清学ANCA检测分为p-ANCA阳性组及p-ANCA阴性组,比较两组实验室指标、病理表现、并发症、使用药物之间有无差异。结果 p-ANCA阳性组较p-ANCA阴性组有更高的抗ds-DNA水平和更低的补体C3水平(P <0. 05)。两组其他实验室指标、病理表现、并发症、使用药物比较,差异均无统计学意义(P> 0. 05)。结论 p-ANCA阳性PLN患者更可能表现为狼疮活跃,p-ANCA或许参与了PLN的病理过程。

Objective To analyze the clinical and pathological features of patients with proliferative lupus nephritis(PLN,typeⅢandⅣin WHO classification)with positive anti-neutrophil cytoplasmic antibody(ANCA)and explore the possible implications of ANCA in the onset and development of PLN.Methods Fifty-four patients were confirmed to be PLN by renal biopsy and were classified into p-ANCA positive group and p-ANCA negative group according to the serological ANCA test.The differences in laboratory indicators,pathological manifestations,complications and drug use between the two groups were compared.Results The p-ANCA positive group had higher serum anti-dsDNA level and lower complement C3 level(P<0.05)than the p-ANCA negative group did.There was no statistically significant difference in other laboratory indicators,pathological manifestations,complications,and drug use between the two groups(P>0.05).Conclusion Patients with p-ANCA positive PLN are more likely to be active in lupus,and p-ANCA may be involved in the pathogenesis of PLN.