[结缔组织弥漫性疾病患者的抗中性粒细胞胞浆抗体]

[Antineutrophil cytoplasmic antibodies in patients with diffuse diseases of connective tissue].

作者信息

Dadonene I, Redaĭtene E, Shaulauskene I, Kirdaĭte G, Vasiliauskene L

出版信息

Ter Arkh. 2002;74(5):38-43.

PMID:12087904

Abstract

AIM

To investigate the significance of antibodies against neutrophil cytoplasmic antigens (ANCA) in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and systemic sclerosis (SS), their relations with the syndromes and laboratory indices.

MATERIAL AND METHODS

The sera from 277 patients suffering from connective tissue disease and 31 healthy persons were examined. Of patients, 103, 126 and 48 had RA, SLE and SS, respectively. The patients in each group were subdivided into ANCA positive (ANCA+) and ANCA negative (ANCA-). The patients were matched within the groups by age, sex and disease duration. There were 41 such pairs in RA group, 23 in SLE and 13 in SS group. Questionnaires and laboratory tests (ANA, RF, a-DNA, a-MPO, a-Scl-70, a-PR3, a-CL) were used in the examination.

RESULTS

The sensitivity of ANCA in SLE patients group was as high as 58.7%, specificity--93.5%. In other groups ANCA were less frequent. ANCA were significantly associated with skin vasculitis and ANA prevalence but the disease activity in SLE was not related to this feature. Anemia and antibodies against cardiolipin were found significantly more frequently in ANCA positive RA group. In SS group the inverted clinical association with kidney damage was seen but a-DNA were more prominent in ANCA+ group. Subspecificity for a-MPO and a-PR3 and lactoferin by ELISA were revealed less often than a-ANCA by immunofluorescence. Only two SLE patients with a-lactoferin antibodies were evidently different in prognosis while the other ones did not differ in the disease course within their group.

CONCLUSION

The ANCA pattern in connective tissue diseases is found rather often but only few clinical and laboratory associations could be established such as skin vasculitis and ANA domination in SLE group, anemia and a-CL in RA group and a-DNA in SS ANCA+ groups. The validity of ANCA test is not so significant as it is in vasculitis patients.

摘要

目的

探讨抗中性粒细胞胞浆抗体（ANCA）在类风湿关节炎（RA）、系统性红斑狼疮（SLE）和系统性硬化症（SS）患者中的意义，及其与综合征和实验室指标的关系。

材料与方法

检测277例结缔组织病患者和31例健康人的血清。其中，103例、126例和48例患者分别患有RA、SLE和SS。每组患者再分为ANCA阳性（ANCA+）和ANCA阴性（ANCA-）。每组患者按年龄、性别和病程进行匹配。RA组有41对，SLE组有23对，SS组有13对。检查采用问卷调查和实验室检测（ANA、RF、α-DNA、α-MPO、α-Scl-70、α-PR3、α-CL）。

结果

SLE患者组中ANCA的敏感性高达58.7%，特异性为93.5%。在其他组中，ANCA出现频率较低。ANCA与皮肤血管炎和ANA患病率显著相关，但SLE的疾病活动与该特征无关。在ANCA阳性的RA组中，贫血和抗心磷脂抗体的发现频率明显更高。在SS组中，观察到与肾损害呈相反的临床关联，但α-DNA在ANCA+组中更为突出。通过ELISA检测α-MPO、α-PR3和乳铁蛋白的亚型特异性，比通过免疫荧光检测α-ANCA的频率更低。只有两名患有α-乳铁蛋白抗体的SLE患者在预后上有明显差异，而其他患者在组内病程上没有差异。