Sebastian Jodi K, Mahr Alfred D, Ahmed Sohail S, Stone John H, Romay-Penabad Zurina, Davis John C, Hoffman Gary S, McCune W Joseph, St Clair E William, Specks Ulrich, Spiera Robert, Pierangeli Silvia, Merkel Peter A
Boston University, Boston, Massachusetts 02118, USA.
J Rheumatol. 2007 May;34(5):1027-31. Epub 2007 Apr 15.
Previous studies in small cohorts of patients with Wegener's granulomatosis (WG) or antineutrophil cytoplasmic antibody (ANCA) associated vasculitis have yielded conflicting data regarding the prevalence of antiendothelial cell antibodies (AECA), ranging from 8% to 100%, and the use of AECA as a measure of disease activity. We examined a large, well-characterized cohort of patients with WG and active disease for the presence of AECA.
Serum from subjects with WG who participated in a clinical therapeutic trial was collected at baseline, when all subjects had active disease. Clinical manifestations and disease activity were documented using the Birmingham Vasculitis Activity Score for WG (BVAS/WG). Serum AECA (IgG) was measured by cyto-ELISA using unfixed human umbilical vein endothelial cells (HUVEC). The AECA positivity cutoff was determined using 71 healthy control samples. Statistical analyses utilized Student's t test, chi-square and Fisher's exact tests, and linear regression.
AECA were detected in 34 of 173 (20%) evaluated serum samples. Mean BVAS/WG did not differ between patients with (7.3 +/- 3.2) or without AECA (7.0 +/- 3.3) (p = 0.58). Among the 34 patients positive for AECA, the antibody titer did not correlate with disease activity (BVAS/WG; r = 0.09, p = 0.60). There were no statistically significant differences in the frequency of major clinical manifestations between patients with or without AECA.
AECA, as measured using HUVEC, are not highly prevalent among patients with active WG, are not associated with specific clinical manifestations, and do not correlate with level of disease activity.
既往针对小样本韦格纳肉芽肿（WG）患者或抗中性粒细胞胞浆抗体（ANCA）相关性血管炎患者的研究，在抗内皮细胞抗体（AECA）的患病率方面得出了相互矛盾的数据，范围从8%至100%，且对于将AECA用作疾病活动度的一项指标也存在争议。我们对一大群特征明确的活动性WG患者进行了研究，以检测AECA的存在情况。
收集参与一项临床治疗试验的WG患者在基线时（此时所有受试者均患有活动性疾病）的血清。使用WG的伯明翰血管炎活动评分（BVAS/WG）记录临床表现和疾病活动度。采用细胞酶联免疫吸附测定法（cyto-ELISA），使用未固定的人脐静脉内皮细胞（HUVEC）检测血清AECA（IgG）。利用71份健康对照样本确定AECA阳性临界值。统计分析采用学生t检验、卡方检验和Fisher精确检验以及线性回归。
在173份接受评估的血清样本中，有34份（20%）检测到AECA。AECA阳性患者（7.3±3.2）与AECA阴性患者（7.0±3.3）的平均BVAS/WG无差异（p = 0.58）。在34例AECA阳性患者中，抗体滴度与疾病活动度（BVAS/WG；r = 0.09，p = 0.60）无相关性。AECA阳性患者与阴性患者在主要临床表现的频率上无统计学显著差异。
采用HUVEC检测时，AECA在活动性WG患者中并非高度普遍存在，与特定临床表现无关，且与疾病活动水平无相关性。
