Terrier B, Saadoun D, Sène D, Ghillani P, Amoura Z, Deray G, Fautrel B, Piette J-C, Cacoub P
Department of Internal Medicine, Groupe Hospitalier Pitié-Salpétrière, 47 boulevard de l'Hôpital, 75013 Paris, France.
Ann Rheum Dis. 2009 Oct;68(10):1564-71. doi: 10.1136/ard.2008.094714. Epub 2008 Oct 28.
To evaluate the relevance of monitoring antimyeloperoxidase antibody levels in the management of antimyeloperoxidase-associated vasculitides.
Thirty-eight patients with antimyeloperoxidase-associated vasculitides were included: microscopic polyangiitis (n = 18), Wegener's granulomatosis (n = 15) and Churg-Strauss syndrome (n = 5). Baseline characteristics and outcomes were recorded. Serial measurements of antimyeloperoxidase antibody levels were performed (ELISA, positive > or = 20 IU/ml).
All patients achieved vasculitis remission after a mean time of 2.0 months (SD 0.9), with a significant decrease in the mean antimyeloperoxidase antibody level at remission (478 vs 41 IU/ml (SD 598 vs 100); p<0.001). Twenty-eight (74%) patients became antimyeloperoxidase antibody negative. After a mean follow-up of 54 months (SD 38), 12 cases of clinical relapse occurred in 11/38 (29%) patients. Relapses were associated with an increase in antimyeloperoxidase antibody levels in 10/11 (91%) patients (34 vs 199 IU/ml (88 vs 314); p = 0.002). The reappearance of antimyeloperoxidase antibodies after achieving negative levels was significantly associated with relapse (odds ratio 117; 95% CI 9.4 to 1450; p<0.001). Antimyeloperoxidase antibodies showed a positive predictive value of 90% and a negative predictive value of 94% for relapse of vasculitis. Up to 60% of cases of relapse occurred less than 12 months after the reappearance of antimyeloperoxidase antibodies. Relapse-free survival was significantly worse for patients who exhibited a reappearance of antimyeloperoxidase antibodies than in those with persistent negative antimyeloperoxidase antibodies (p<0.001). The antimyeloperoxidase antibodies serum level was strongly correlated with the Birmingham vasculitis activity score and the disease extent index (r = +0.49; p = 0.002).
Through monitoring, antimyeloperoxidase antibodies are a useful marker of disease activity and a good predictor of relapse in antimyeloperoxidase-associated vasculitides.
评估监测抗髓过氧化物酶抗体水平在抗髓过氧化物酶相关血管炎管理中的相关性。
纳入38例抗髓过氧化物酶相关血管炎患者：显微镜下多血管炎（n = 18）、韦格纳肉芽肿（n = 15）和变应性肉芽肿性血管炎（n = 5）。记录基线特征和结局。进行抗髓过氧化物酶抗体水平的系列测量（酶联免疫吸附测定，阳性>或 = 20 IU/ml）。
所有患者在平均2.0个月（标准差0.9）后实现血管炎缓解，缓解时抗髓过氧化物酶抗体平均水平显著降低（478 vs 41 IU/ml（标准差598 vs 100）；p<0.001）。28例（74%）患者抗髓过氧化物酶抗体转为阴性。平均随访54个月（标准差38）后，11/38（29%）例患者发生12次临床复发。10/11（91%）例复发患者的复发与抗髓过氧化物酶抗体水平升高相关（34 vs 199 IU/ml（88 vs 314）；p = 0.002）。抗髓过氧化物酶抗体水平在达到阴性后再次出现与复发显著相关（比值比117；95%可信区间9.4至1450；p<0.001）。抗髓过氧化物酶抗体对血管炎复发的阳性预测值为90%，阴性预测值为94%。高达60%的复发病例在抗髓过氧化物酶抗体再次出现后不到12个月发生。抗髓过氧化物酶抗体再次出现的患者的无复发生存期显著差于抗髓过氧化物酶抗体持续阴性的患者（p<0.001）。抗髓过氧化物酶抗体血清水平与伯明翰血管炎活动评分和疾病范围指数密切相关（r = +0.49；p = 0.002）。
通过监测，抗髓过氧化物酶抗体是抗髓过氧化物酶相关血管炎疾病活动的有用标志物和复发的良好预测指标。
