Kroeger Knut, Kreuzfelder Ernst
Klinik und Poliklinik für Angiologie, Universitätsklinik Essen, Essen.
Herz. 2004 Feb;29(1):26-31. doi: 10.1007/s00059-004-2548-6.
In patients with early manifestation of peripheral arterial occlusive disease (PAOD) and a less classical atherosclerotic risk profile, vasculitis is presumed to be the underlying disease. We performed a prospective study of the importance of determination of autoantibodies used for the diagnosis of vasculitis and collagen diseases in patients with symptomatic PAOD.
698 consecutive patients (mean age +/- SD: 68 +/- 10 years) were included who were referred from 1998 to 1999 for interventional treatment of PAOD. In 121 PAOD-patients (61 +/- 12 years) with a less pronounced atherosclerotic risk profile, or rarefied distal arteries without sclerosis of the media, or elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) independent from the stage IV of PAOD, the following autoantibodies were investigated: antinuclear antibodies (ANA), antibodies against extractable nuclear antigens (ENA): SCL 70, RNP, SS-A, SS-B, Jo-1, SM), double-stranded DNA antibodies (ds-DNA), antineutrophil cytoplasmatic antibodies (c- and p-ANCA), antiphospholipid antibodies [phosphatidylserine (APSA) and beta(2)-glycoprotein], smooth (SMA) and striated muscle (StrMA). ANA, SMA and StrMA were estimated by indirect immunofluorescence technique, ENA by Western-blot and the others by enzyme linked immunoassay.
38 PAOD-patients (35%) had increased autoantibody concentrations. The rate of different PAOD stages and localization did not differ between the group of patients with increased autoantibody concentrations and the group of patients without. But the group of patients with increased autoantibody concentrations had higher rates of elevated ESR [p-value of 0.0043, odds ratio of 7.1 (95% CI: 1.49-33.81)]. ANA were the most frequent autoantibodies detected in 17 (14%) of the 121 patients followed by APSA and autoantibodies directed against beta(2)-glycoprotein. During follow-up of 24 +/- 6 months no vasculitis or collagen diseases associated with the elevated autoantibody concentrations became clinically manifest in the 38 patients. Two patients died due to coronary heart disease. Four patients had a worsening of their PAOD but no amputation was performed. Out of the 83 patients without elevated concentrations of autoantibodies, eight patients died and three amputations were carried out.
All in all, increased autoantibody concentrations in patients suffering from peripheral atherosclerosis are not a rare finding. A systematic determination of autoantibodies, especially in patients with a low atherosclerotic risk profile, does not increase the number of manifest or developing vasculitis of collagen disease.
在外周动脉闭塞性疾病（PAOD）早期表现且动脉粥样硬化风险特征不典型的患者中，血管炎被认为是潜在病因。我们对有症状的PAOD患者中用于诊断血管炎和胶原病的自身抗体检测的重要性进行了一项前瞻性研究。
纳入了1998年至1999年因PAOD介入治疗而转诊的698例连续患者（平均年龄±标准差：68±10岁）。在121例PAOD患者（61±12岁）中，这些患者动脉粥样硬化风险特征不明显，或远端动脉稀疏且中膜无硬化，或红细胞沉降率（ESR）或C反应蛋白（CRP）升高且与PAOD的IV期无关，检测了以下自身抗体：抗核抗体（ANA）、抗可提取核抗原（ENA）抗体：SCL 70、RNP、SS - A、SS - B、Jo - 1、SM）、双链DNA抗体（ds - DNA）、抗中性粒细胞胞浆抗体（c - 和p - ANCA）、抗磷脂抗体[磷脂酰丝氨酸（APSA）和β2糖蛋白]、平滑肌（SMA）和横纹肌（StrMA）。ANA、SMA和StrMA通过间接免疫荧光技术检测，ENA通过免疫印迹法检测，其他通过酶联免疫吸附测定法检测。
38例PAOD患者（35%）自身抗体浓度升高。自身抗体浓度升高组和未升高组患者的不同PAOD分期和部位发生率无差异。但自身抗体浓度升高组患者ESR升高的比例更高[P值为0.0043，优势比为7.1（95%可信区间：1.49 - 33.81）]。ANA是121例患者中最常检测到的自身抗体，17例（14%）患者检测到，其次是APSA和抗β2糖蛋白的自身抗体。在24±6个月的随访中，38例自身抗体浓度升高的患者未出现与自身抗体浓度升高相关的血管炎或胶原病临床表现。2例患者死于冠心病。4例患者的PAOD病情恶化，但未进行截肢。在83例自身抗体浓度未升高的患者中，8例患者死亡，3例进行了截肢。
总体而言，外周动脉粥样硬化患者自身抗体浓度升高并非罕见现象。系统性检测自身抗体，尤其是在动脉粥样硬化风险特征较低的患者中，并不会增加明显的或正在发生的胶原病血管炎的数量。
