Defendenti Caterina, Spina Maria Francesca, Grosso Silvia, Longo Margherita, Bollani Simona, Cereda Aldo, Saibeni Simone, Guercilena Giacinto, Atzeni Fabiola, Sarzi-Puttini Piercarlo
Laboratorio di Analisi, Ospedale Fatebenefratelli, Milano.
Recenti Prog Med. 2010 Jan;101(1):16-26.
Serologic and clinical aspects of 50 positives patients for antineutrophil cytoplasmic antibodies (ANCA) have been evaluated (age range 7-94 years, mean age 43 years). 40 (80%) were females. Antineutrophil nuclear antibodies (pANNA), in which the antigenic specificity is unknown, were detected in seventeen patients (34%). About half of these cases (8 patients) had primary sclerosing cholangitis and other 7 patients had severe ulcerative colitis. Two pANNA patients, with increased susceptibility to infections, had undefined diagnosis. Both had thalassemic trait. Anti MPO were detected in 9 patients in which segmental lesions prevail and anti-PR3 were detected in 9 patients with granulomatous component. The patients with higher levels of these autoantibodies (40%) had the typical syndromes described in literature (vasculitis ANCA-related) although patients with lower autoantibodies levels (60%) mostly present variable clinical symptoms with unspecified diagnosis. Fourteen patients were positive for atypical ANCA detectable with commercial kits. They present variable clinical symptoms with unspecified diagnosis but show granulomatous or neoplastic lungs and bowel involvement. Both have mostly contact with environmental microorganisms. All cases are characterized by chronic inflammatory lesions in which the relapses correlate with infectious disorder.
对50例抗中性粒细胞胞浆抗体(ANCA)阳性患者的血清学和临床情况进行了评估(年龄范围7 - 94岁,平均年龄43岁)。其中40例(80%)为女性。17例患者(34%)检测到抗中性粒细胞核抗体(pANNA),其抗原特异性未知。这些病例中约一半(8例)患有原发性硬化性胆管炎,另外7例患有严重溃疡性结肠炎。2例pANNA患者易感染,诊断不明确。两人均有地中海贫血特征。9例以节段性病变为主的患者检测到抗MPO,9例有肉芽肿成分的患者检测到抗PR3。这些自身抗体水平较高的患者(40%)具有文献中描述的典型综合征(ANCA相关血管炎),而自身抗体水平较低的患者(60%)大多表现为临床症状多样且诊断不明确。14例患者用商业试剂盒检测出非典型ANCA阳性。他们表现出临床症状多样且诊断不明确,但显示有肉芽肿性或肿瘤性肺和肠道受累。两者大多与环境微生物接触。所有病例均以慢性炎症性病变为特征,其中复发与感染性疾病相关。