Schmitt Wilhelm H, van der Woude Fokko J
Vth Medical Clinic (Nephrology, Endocrinolgy, Rheumatolgy), University-Clinic Mannheim, Faculty of Clinical Medicine of the University of Heidelberg, Mannheim, Germany.
Curr Opin Rheumatol. 2004 Jan;16(1):9-17. doi: 10.1097/00002281-200401000-00004.
Antineutrophil cytoplasmic antibodies are closely associated with Wegener granulomatosis, microscopic polyangiitis, and Churg-Strauss syndrome and have contributed to new pathogenetic concepts and improved nomenclature of systemic vasculitides (antineutrophil cytoplasmic antibody-associated vasculitides). However, the application of antineutrophil cytoplasmic antibody testing as a clinical diagnostic tool is still regarded as controversial. This review summarizes the most recent developments in the field, identifies areas of uncertainty, and gives practical guidelines.
The problems of antineutrophil cytoplasmic antibody testing include the diversity of antineutrophil cytoplasmic antibody target antigens, assay standardization and performance, the application of antineutrophil cytoplasmic antibody testing in a clinical setting with a low pretest probability, and, finally, the widespread assumption that antineutrophil cytoplasmic antibody titers alone may closely reflect disease activity and therefore may be used to guide therapy.
Recent findings demonstrate that the combined use of indirect immunofluorescence tests and solid phase assays to detect antineutrophil cytoplasmic antibody directed against myeloperoxidase and proteinase 3 can minimize the occurrence of false-positive antineutrophil cytoplasmic antibody results. Furthermore, the yield of antineutrophil cytoplasmic antibody testing can be improved by the use of a well-standardized test, adherence to published guidelines, and restricting the use of the tests to clinical situations with a rather high pretest probability for antineutrophil cytoplasmic antibody-associated vasculitides. However, treatment decisions should be based on the clinical presentation of the patient and histologic findings and not on the results of antineutrophil cytoplasmic antibody testing alone.
抗中性粒细胞胞浆抗体与韦格纳肉芽肿、显微镜下多血管炎及变应性肉芽肿性血管炎密切相关，有助于形成新的发病机制概念并改进系统性血管炎（抗中性粒细胞胞浆抗体相关性血管炎）的命名。然而，抗中性粒细胞胞浆抗体检测作为临床诊断工具的应用仍存在争议。本综述总结了该领域的最新进展，明确了不确定领域，并给出实用指南。
抗中性粒细胞胞浆抗体检测存在诸多问题，包括抗中性粒细胞胞浆抗体靶抗原的多样性、检测方法的标准化及性能、抗中性粒细胞胞浆抗体检测在临床前概率较低情况下的应用，以及最后普遍认为仅抗中性粒细胞胞浆抗体滴度可密切反映疾病活动度并因此可用于指导治疗。
最新发现表明，联合使用间接免疫荧光试验和固相检测法来检测抗髓过氧化物酶和蛋白酶3的抗中性粒细胞胞浆抗体，可最大程度减少抗中性粒细胞胞浆抗体假阳性结果的发生。此外，通过使用标准化良好的检测方法、遵循已发表的指南，并将检测应用于抗中性粒细胞胞浆抗体相关性血管炎临床前概率较高的临床情况，可提高抗中性粒细胞胞浆抗体检测的阳性率。然而，治疗决策应基于患者的临床表现和组织学检查结果，而不能仅依据抗中性粒细胞胞浆抗体检测结果。
