Division of Immunology, HSSA Pathology Queensland Central Laboratory, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
Am J Clin Pathol. 2013 Aug;140(2):184-92. doi: 10.1309/AJCP4Y8ADMKOSCXV.
To investigate whether discriminating the classic perinuclear antineutrophil cytoplasmic antibody (P-ANCA) pattern from atypical P-ANCA and uninterpretable patterns improves the diagnostic utility of ANCA testing.
All ANCA requests (n = 3,544) referred to Pathology Queensland were analyzed prospectively over 4 months for P-ANCA pattern subtypes and myeloperoxidase (MPO)-ANCA/PR3-ANCA results and correlated with clinical, laboratory, and radiologic evidence of necrotizing small vessel vasculitis.
Of the 436 perinuclear immunofluorescence-positive samples, 45 were classic P-ANCA, 163 were atypical P-ANCA, and 228 were antinuclear antibodies/uninterpretable. The classic P-ANCA pattern had a significantly stronger association with vasculitis (30/45) than atypical P-ANCA (2/163) (P <.0001) or ANA/uninterpretable patterns (8/228) (P <.0001). The combination of a classic P-ANCA pattern and positive MPO-ANCA/PR3-ANCA result was also more strongly associated with vasculitis than a positive MPO-ANCA/PR3-ANCA result in isolation (P = .003).
This study demonstrates that reporting different P-ANCA patterns (including ANA/uninterpretable patterns) provides additional diagnostic information to MPO-ANCA/PR3-ANCA results.
研究区分经典的核周型抗中性粒细胞胞质抗体（p-anca）模式与非典型 p-anca 和不可解释模式是否能提高anca 检测的诊断效用。
在 4 个月的时间里，对昆士兰病理学的所有 anca 请求（n=3544）进行前瞻性分析，以确定 p-anca 模式亚型和髓过氧化物酶（mpo）-anca/pr3-anca 结果，并与坏死性小血管血管炎的临床、实验室和影像学证据相关联。
在 436 份核周免疫荧光阳性样本中，有 45 份为经典 p-anca，163 份为非典型 p-anca，228 份为抗核抗体/不可解释。经典 p-anca 模式与血管炎的相关性明显强于非典型 p-anca（2/163）（p<.0001）或抗核抗体/不可解释模式（8/228）（p<.0001）。经典 p-anca 模式与阳性 mpo-anca/pr3-anca 结果的组合也与孤立的 mpo-anca/pr3-anca 结果阳性（p=0.003）具有更强的相关性。
本研究表明，报告不同的 p-anca 模式（包括抗核抗体/不可解释模式）为 mpo-anca/pr3-anca 结果提供了额外的诊断信息。
