Domingues Vital Manuel Da Silva, Machado Bernardete, Santos Josefina
MD - Resident in Internal Medicine at Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal.
MD - Hospital Assistant of Nephrology at Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal.
Rev Assoc Med Bras (1992). 2016 Sep-Oct;62(5):434-40. doi: 10.1590/1806-9282.62.05.434.
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is an autoimmune disease that can affect multiple organs, the kidney being one of the most affected. Apart from the diagnostics value of ANCA, they have also been advocated as biomarkers of the disease activity. Recently, the genetic changes found in polyangiitis associated with serine-protease proteinase 3 (PR3)-ANCA or myeloperoxidase (MPO)-ANCA raised the possibility of immune-pathogenic and therapeutic differences.
To identify differences in the number of relapses, inflammatory markers, outcomes and renal histology related to the types of ANCA. To analyze the implications of ANCA titers in prognosis.
A retrospective observational study in a Portuguese tertiary hospital.
There were no differences in the progression of renal function, histological pattern and initial treatment with regard to ANCA subtypes. As for the evaluated parameters, there were no significant differences according to the types of ANCA, except for mean CRP values within the normal range, which was 6.3±1.3 mg/L for MPO-ANCA and 12.4±10.14 mg/L for PR3-ANCA (p=0.04). We found that 66.7% of the MPO-ANCA-positive showed no relapses versus 40% in the case of PR3-ANCA-positive. There was no correlation between the ANCA titers at presentation, during remission, and in the last evaluation, and the number of relapses.
PR3-ANCA patients have a mean CRP value within the normal range significantly higher than that of MPO-ANCA patients (p=0.04), which seems to reveal greater inflammatory activity in the first.
抗中性粒细胞胞浆抗体（ANCA）相关血管炎是一种可累及多个器官的自身免疫性疾病，肾脏是最常受累的器官之一。除了ANCA的诊断价值外，它们还被认为是疾病活动的生物标志物。最近，在与丝氨酸蛋白酶蛋白酶3（PR3）-ANCA或髓过氧化物酶（MPO）-ANCA相关的多血管炎中发现的基因变化增加了免疫致病和治疗差异的可能性。
确定与ANCA类型相关的复发次数、炎症标志物、结局和肾脏组织学的差异。分析ANCA滴度对预后的影响。
在一家葡萄牙三级医院进行回顾性观察研究。
就ANCA亚型而言，肾功能进展、组织学模式和初始治疗方面没有差异。至于评估参数，根据ANCA类型没有显著差异，除了平均CRP值在正常范围内，MPO-ANCA为6.3±1.3mg/L，PR3-ANCA为12.4±10.14mg/L（p=0.04）。我们发现，66.7%的MPO-ANCA阳性患者无复发，而PR3-ANCA阳性患者为40%。就诊时、缓解期和最后评估时的ANCA滴度与复发次数之间没有相关性。
PR3-ANCA患者的平均CRP值在正常范围内显著高于MPO-ANCA患者（p=0.04），这似乎表明前者具有更强的炎症活动。
