Tervaert J W, Limburg P C, Elema J D, Huitema M G, Horst G, The T H, Kallenberg C G
Department of Internal Medicine, University Hospital, Groningen, The Netherlands.
Am J Med. 1991 Jul;91(1):59-66. doi: 10.1016/0002-9343(91)90074-8.
Assessment of the value of determination of antineutrophil cytoplasmic antibodies (ANCA) and its specificities for classification of patients with biopsy-proven necrotizing arteritis.
The serum samples of 28 consecutive patients with biopsy-proven vasculitis involving medium- and/or small-sized arteries were tested for ANCA by an indirect immunofluorescence technique, by neutrophil extract enzyme-linked immunosorbent assay (ELISA), and by catching ELISA.
Eight patients had Churg-Strauss syndrome; six had myeloperoxidase (MPO) antibodies, and in the other two patients, ANCA were not detected. Six patients had polyarteritis nodosa (PAN) limited to the skin and the musculoskeletal system; ANCA were not detected in these patients. Two patients had systemic PAN and both had MPO antibodies. The remaining 12 patients had overlapping clinical features of the different forms of vasculitis. Five patients had polyarteritis in combination with chronic nasal inflammation and glomerulonephritis compatible with Wegener's granulomatosis (WG) but without granulomas in the respiratory tract. All five patients had 29-kd serine protease antibodies. Two patients had polyarteritis in combination with nasal polyposis and asthma compatible with Churg-Strauss syndrome, but eosinophilia was not detected. Both patients had MPO antibodies. Three patients with unclassified granulomatous arteritis had either elastase antibodies or ANCA of unknown specificity. One patient with unclassified systemic vasculitis had 29-kd serine protease antibodies, and one patient with necrotizing arteritis of the bowel in combination with Schönlein-Henoch purpura was negative for ANCA.
Determination of ANCA and its specificities is a useful adjunct to the classification of patients with biopsy-proven necrotizing arteritis. Within the spectrum of idiopathic vasculitides, 29-kd serine protease antibodies are associated with WG, MPO antibodies are associated with Churg-Strauss syndrome and systemic PAN, and PAN limited to the skin and the musculoskeletal system is not associated with ANCA.
评估抗中性粒细胞胞浆抗体（ANCA）检测的价值及其在经活检证实的坏死性动脉炎患者分类中的特异性。
采用间接免疫荧光技术、中性粒细胞提取物酶联免疫吸附测定（ELISA）及捕获ELISA法，对28例经活检证实患有累及中、小动脉的血管炎的连续患者的血清样本进行ANCA检测。
8例患者患有变应性肉芽肿性血管炎；6例有髓过氧化物酶（MPO）抗体，另外2例未检测到ANCA。6例患者患有局限于皮肤和肌肉骨骼系统的结节性多动脉炎（PAN）；这些患者未检测到ANCA。2例患者患有系统性PAN，均有MPO抗体。其余12例患者具有不同形式血管炎的重叠临床特征。5例患者的多动脉炎合并慢性鼻炎症和与韦格纳肉芽肿病（WG）相符的肾小球肾炎，但呼吸道无肉芽肿。所有5例患者均有29-kd丝氨酸蛋白酶抗体。2例患者的多动脉炎合并鼻息肉病和与变应性肉芽肿性血管炎相符的哮喘，但未检测到嗜酸性粒细胞增多。2例患者均有MPO抗体。3例未分类的肉芽肿性动脉炎患者有弹性蛋白酶抗体或特异性不明的ANCA。1例未分类的系统性血管炎患者有29-kd丝氨酸蛋白酶抗体，1例肠坏死性动脉炎合并过敏性紫癜患者ANCA阴性。
ANCA及其特异性检测有助于经活检证实的坏死性动脉炎患者的分类。在特发性血管炎范围内，29-kd丝氨酸蛋白酶抗体与WG相关，MPO抗体与变应性肉芽肿性血管炎和系统性PAN相关，局限于皮肤和肌肉骨骼系统的PAN与ANCA无关。
