Chen Min, Yu Feng, Wang Su-Xia, Zou Wan-Zhong, Zhang Ying, Zhao Ming-Hui, Wang Hai-Yan
Renal Division and Institute of Nephrology, Peking University First Hospital, Beijing 100034, PR China.
Nephrol Dial Transplant. 2007 Jan;22(1):139-45. doi: 10.1093/ndt/gfl509. Epub 2006 Sep 15.
Proteinase-3 antineutrophil cytoplasmic antibody (PR3-ANCA) was the serological marker for Wegener's granulomatosis (WG), while myeloperoxidase (MPO)-ANCA was the serological marker for microscopic polyangiitis (MPA). However, our previous study suggested that patients with MPO-ANCA positive WG were common in Chinese. This study aimed to analyse the renal histology of patients with MPO-ANCA positive WG.
Patients in our centre with WG were selected according to both the Chapel Hill Consensus Conference (CHCC) definition and American College of Rheumatology classification criteria. Patients with MPA were selected according to the CHCC definition. The renal histology was compared between patients with MPO-ANCA positive WG and with PR3-ANCA positive WG as well as patients with MPO-ANCA positive MPA.
Sixty-one patients with WG had complete renal histological data, 39/61 with positive MPO-ANCA and 22/61 with positive PR3-ANCA. Among patients with crescents in glomeruli, those with MPO-ANCA had fewer cellular crescents and more fibrous crescents than those with PR3-ANCA (P < 0.01 and P < 0.05, respectively). Interstitial fibrosis and tubular atrophy were more prevalent and severe in patients with MPO-ANCA than in those with PR3-ANCA (P < 0.01 and P < 0.05, respectively). Compared with 44 patients with MPO-ANCA positive MPA, patients with MPO-ANCA positive WG had fewer glomeruli with crescents and more normal glomeruli (P < 0.01 and P < 0.01, respectively).
Patients with MPO-ANCA positive WG are common in Chinese. In renal histology, chronic lesions were more severe and prevalent in patients with MPO-ANCA positive WG than in patients with PR3-ANCA positive WG. Glomerular lesions were less severe and less prevalent in patients with MPO-ANCA positive WG than in those with MPO-ANCA positive MPA.
蛋白酶3抗中性粒细胞胞浆抗体（PR3-ANCA）是韦格纳肉芽肿（WG）的血清学标志物，而髓过氧化物酶（MPO）-ANCA是显微镜下多血管炎（MPA）的血清学标志物。然而，我们之前的研究表明，MPO-ANCA阳性的WG患者在中国很常见。本研究旨在分析MPO-ANCA阳性WG患者的肾脏组织学情况。
根据查珀尔希尔共识会议（CHCC）定义和美国风湿病学会分类标准，选择我们中心的WG患者。根据CHCC定义选择MPA患者。比较MPO-ANCA阳性WG患者、PR3-ANCA阳性WG患者以及MPO-ANCA阳性MPA患者的肾脏组织学情况。
61例WG患者有完整的肾脏组织学数据，39/61例MPO-ANCA阳性，22/61例PR3-ANCA阳性。在肾小球有新月体的患者中，MPO-ANCA阳性患者的细胞性新月体比PR3-ANCA阳性患者少，纤维性新月体比PR3-ANCA阳性患者多（分别为P<0.01和P<0.05）。MPO-ANCA阳性患者的间质纤维化和肾小管萎缩比PR3-ANCA阳性患者更普遍、更严重（分别为P<（此处原文有误，推测应为P<0.01和P<0.05））。与44例MPO-ANCA阳性MPA患者相比，MPO-ANCA阳性WG患者有新月体的肾小球较少，正常肾小球较多（分别为P<0.01和P<0.01）。
MPO-ANCA阳性的WG患者在中国很常见。在肾脏组织学方面，MPO-ANCA阳性WG患者的慢性病变比PR3-ANCA阳性WG患者更严重、更普遍。MPO-ANCA阳性WG患者的肾小球病变比MPO-ANCA阳性MPA患者更轻、更不普遍。
