Institute of Allergy and Clinical Immunology, Clinical Center of Serbia, Belgrade, Serbia.
Clin Rheumatol. 2010 Aug;29(8):893-904. doi: 10.1007/s10067-010-1424-4. Epub 2010 Mar 20.
Chronic infections may mimic antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV). We investigated which markers may help in the diagnosis and the prognosis of infections associated with proteinase 3 (PR3) and myeloperoxidase (MPO)-ANCA. In this study (1993-2008)--with an average follow-up of 5.1 years--we compared 66 AAV patients with 17 PR3 and/or MPO-ANCA-positive patients with protracted bacterial (11/17) or viral (6/17) infections. Seven of 17 patients had subacute bacterial endocarditis (SBE), while six of 17 patients had various autoimmune manifestations of chronic hepatitis C virus (HCV) infection. We determined ANCA, antinuclear antibodies, anti-PR3, anti-MPO, anticardiolipin (aCL), antibeta 2 glycoprotein I (beta2-GP I), cryoglobulins, C3, and C4. Patients with infections were younger than AAV patients (p < 0.01). There was no difference in frequency of renal and skin lesions. AAV patients more frequently had pulmonary and nervous system manifestations (p < 0.01). Patients with infections more frequently had dual ANCA (high PR3, low MPO), aCL, anti-beta2-GP I, cryoglobulins, and hypocomplementemia (p < 0.001). Immunosuppressive therapy (IST) was used in five 17 patients who had persistently high ANCA, cryoglobulinemia, and hypocomplementemia. There was no difference in frequency of lethality and renal failure in the two study groups. In patients who are PR3- and/or MPO-ANCA positive, SBE and HCV infection should be excluded. Although similar in renal and skin manifestations in comparison to AAV, only patients with infections developed multiple serological abnormalities. In patients with infections, concomitant presence of ANCA, cryoglobulins, and hypocomplementemia was associated with severe glomerulonephritis. The serological profile should be repeated after specific antimicrobial or surgical therapy, since some cases might require IST.
慢性感染可能与抗中性粒细胞胞质抗体（ANCA）相关血管炎（AAV）相似。我们研究了哪些标志物可能有助于诊断和预测与蛋白酶 3（PR3）和髓过氧化物酶（MPO）-ANCA 相关的感染。在这项研究中（1993-2008 年）-平均随访 5.1 年-我们比较了 66 例 AAV 患者和 17 例 PR3 和/或 MPO-ANCA 阳性的患者，其中 17 例患者分别发生了迁延性细菌性（11/17）或病毒性（6/17）感染。17 例患者中有 7 例患有亚急性细菌性心内膜炎（SBE），6 例患有慢性丙型肝炎病毒（HCV）感染的各种自身免疫表现。我们测定了 ANCA、抗核抗体、抗 PR3、抗 MPO、抗心磷脂（aCL）、抗β2 糖蛋白 I（β2-GP I）、冷球蛋白、C3 和 C4。感染患者比 AAV 患者年轻（p<0.01）。肾脏和皮肤病变的发生率无差异。AAV 患者更常出现肺部和神经系统表现（p<0.01）。感染患者更常出现双 ANCA（高 PR3、低 MPO）、aCL、抗β2-GP I、冷球蛋白和低补体血症（p<0.001）。17 例患者中有 5 例持续存在高 ANCA、冷球蛋白血症和低补体血症，使用了免疫抑制治疗（IST）。两组患者的死亡率和肾衰竭发生率无差异。在 PR3 和/或 MPO-ANCA 阳性的患者中，应排除 SBE 和 HCV 感染。与 AAV 相比，感染患者的肾脏和皮肤表现相似，但只有感染患者出现了多种血清学异常。在感染患者中，同时存在 ANCA、冷球蛋白和低补体血症与严重肾小球肾炎相关。由于某些病例可能需要 IST，因此应在特定的抗菌或手术治疗后重复血清学检查。
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