抗中性粒细胞胞质抗体在心脑血管疾病患者中的分布特征

Distribution of anti-neutrophil cytoplasmic antibody in patients with cardiovascular and cerebrovascular diseases

目的探讨抗中性粒细胞胞质抗体(ANCA)在心脑血管疾病患者中的分布特点及临床特征。方法收集并分析2015年1月—2019年7月期间就诊于保定市第一中心医院的6759例心脑血管患者的临床资料。ANCA检测采用间接免疫荧光法(IIF),抗髓过氧化物酶(MPO)和抗蛋白酶3(PR3)抗体检测采用酶联免疫吸附法(ELISA)。结果6759例患者中558例ANCA阳性,阳性率为8.26%(558/6759),其中382例为核周型(p-ANCA),占68.46%(382/558),176例为细胞质型(c-ANCA),占31.54%(176/558)。ANCA阳性患者中抗MPO及抗PR3抗体阳性者共69例,明显低于抗其他靶抗原抗体阳性患者(489例),二者之比为1∶7.09。ANCA阳性患者中,反复呼吸道感染发生率为69.35%(387/558),肺间质病变发生率为64.52%(360/558),明显高于阴性患者组[40.51%(2512/6201)和33.17%(2057/6201)]。结论针对靶抗原MPO及PR3抗体的检测法不能代替IIF法检测总ANCA,否则会造成严重漏诊,及早检测ANCA对慢性心脑血管疾病患者意义重大。

Objective To investigate the distribution features of anti-neutrophil cytoplasmic antibody(ANCA)in patients with cardiovascular and cerebrovascular diseases and the clinical characteristics of the patients.Methods Clinical data of 6759 patients who were treated in Baoding No.1 Central Hospital for cardiovascular and cerebrovascular diseases during January 2015 to July 2019 were collected and analyzed.ANCA was detected by indirect immunofluorescence(IIF).Antibodies against myeloperoxidase(MPO)and protease 3(PR3)were detected by enzyme-linked immunosorbent assay(ELISA).Results IIF showed that 558 out of the 6759 cases tested positive for ANCA with a positive rate of 8.26%.Among them,382(68.46%)were positive for perinuclear ANCA(p-ANCA)and 176(31.54%)were positive for cytoplasmic ANCA(c-ANCA).Anti-MPO and anti-PR3 antibodies were detected in 69 ANCA-positive cases,while the antibodies against other target antigens were detected in 489 cases.The ratio between the two groups was 1∶7.09.The incidence of recurrent respiratory tract infection and pulmonary interstitial lesions in ANCA-positive cases was 69.35%(387/558)and 64.52%(360/558),respectively,which was significantly higher than that in ANCA-negative patients[40.51%(2512/6201)and 33.17%(2057/6201)].Conclusions Anti-MPO and anti-PR3 antibody detection could not replace IIF to detect total ANCA for a high rate of missed diagnosis would be caused.Early detection of ANCA would be of great significance to patients with chronic cardiovascular and cerebrovascular diseases.