ANCA及其特异性抗体在SLE患者中的应用价值初探

Preliminary study on the application value of ANCA and its specific antibody in SLE patients

目的探讨抗中性粒细胞胞质抗体(ANCA)及其特异性抗体阳性的系统性红斑狼疮(SLE)患者各实验室指标特点,分析ANCA及其特异性抗体检测在SLE患者中的应用价值。方法回顾性分析四川大学华西医院2011年1月至2019年4月诊断为SLE的患者共329例,根据ANCA、乳铁蛋白(LF)-ANCA及髓过氧化物酶(MPO)-ANCA的检测结果对患者进行分组,同时收集患者与SLE活动性相关的实验室指标[补体成分3(C3)、补体成分4(C4)、白细胞(WBC)计数、血小板计数、抗dsDNA抗体]及其他常规实验室检测指标[红细胞沉降率(ESR)、C反应蛋白(CRP)、免疫球蛋白(Ig)A、IgG、IgM、血肌酐(Scr)、尿素(UREA)、胱抑素C(Cys-C)、尿酸(UA)、估算的肾小球滤过率(eGFR)、类风湿因子(RF)]。结果ANCA阳性组ESR、CRP、IgA、IgG、Cys-C、UREA、UA水平及抗dsDNA抗体、RF阳性率高于ANCA阴性组,而C3、C4、WBC水平则低于ANCA阴性组,差异均有统计学意义(P<0.05);LF-ANCA阳性组的C3、C4、Cys-C、UA、WBC水平低于LF-ANCA阴性组,而ESR、CRP、IgA、IgG水平及抗dsDNA抗体、RF阳性率高于LF-ANCA阴性组,差异均有统计学意义(P<0.05);MPO-ANCA阳性组的肾功能相关指标UREA、Cys-C水平高于MPO-ANCA阴性组,而eGFR低于MPO-ANCA阴性组,差异均有统计学意义(P<0.05)。结论ANCA尤其是LF-ANCA阳性的SLE患者可能有疾病活动性增高的风险,临床应更积极地评价SLE的疾病活动性,而MPO-ANCA阳性的SLE患者肾损伤更重,在SLE患者临床诊疗中应重视ANCA及其特异性抗体检测。

Objective To investigate the characteristics of various laboratory indexes in patients with systemic lupus erythematosus(SLE)with positive antineutrophil cytoplasmic antibody(ANCA)and its specific antibody,and to analyze the application value of ANCA and its specific antibody detection in SLE patients.Methods A total of 329 patients diagnosed with SLE from January 2011 to April 2019 in West China Hospital of Sichuan University were retrospectively analyzed and divided into groups based on the test results of ANCA,lactoferrin(LF)-ANCA and myeloperoxidase(MPO)-ANCA.At the same time,the laboratory indicators related to SLE activity[complement 3(C3),complement 4(C4),white blood cell(WBC)count,platelet count,anti-dsDNA antibody]and other routine laboratory test indicators[erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),immunoglobulin(Ig)A,IgG,IgM,serum creatinine(Scr),urea(UREA),cystatin C(Cys-C),uric acid(UA),estimated glomerulus Filtration rate(eGFR),rheumatoid factor(RF)]were collected.Results The levels of ESR,CRP,IgA,IgG,Cys-C,UREA,UA,anti-dsDNA antibody and RF positive rates of the ANCA positive group were higher than those of the ANCA negative group,while the levels of C3,C4 and WBC were lower than those of the ANCA negative group,the differences were statistically significant(P<0.05);The levels of C3,C4,Cys-C,UA,WBC of the LF-ANCA positive group were lower than those of the LF-ANCA negative group,while the levels of ESR,CRP,IgA,IgG and the positive rates of anti dsDNA antibody and RF were higher than those of the LF-ANCA negative group,the differences were statistically significant(P<0.05);The levels of UREA and Cys-C of the MPO-ANCA positive group were higher than those of the MPO-ANCA negative group,while while eGFR was lower than that of the MPO-AN-CA negative group,the differences were statistically significant(P<0.05).Conclusion SLE patients with ANCA,especially those with LF-ANCA positive,may have the risk of increased disease activity.Clinically,the disease activity of SLE should be evaluated more actively.SLE patients with positive MPO-ANCA have more severe kidney damage.The detection of ANCA and its specific antibodies should be emphasized in the clinical diagnosis and treatment of SLE patients.