Csernok E, Kempiners N, Hellmich B
Referenzlabor für Vaskulitis-Immundiagnostik, Vaskulitiszentrum Süd, Klinik für Innere Medizin, Rheumatologie und Immunologie, Kreiskliniken Esslingen gGmbH, Klinik Kirchheim, Akademisches Lehrkrankenhaus der Universität Tübingen, Eugenstr. 3, 73230, Kirchheim unter Teck, Deutschland.
Z Rheumatol. 2017 Mar;76(2):143-148. doi: 10.1007/s00393-016-0240-x.
Up to now indirect immunofluorescence (IIF) followed by an antigen-specific assay specific for proteinase 3 (PR3) or myeloperoxidase (MPO) has been the standard method for the detection of antineutrophil cytoplasmic antibodies (ANCA). The development of more sensitive and highly specific PR3-ANCA and MPO-ANCA immunoassays for the diagnosis of ANCA-associated vasculitis (AAV) has raised doubts about the two-stage diagnostic strategy currently recommended for ANCA detection.
Presentation and discussion of the new international consensus recommendations on ANCA testing in AAV.
This article presents the new guidelines for ANCA testing that have been developed based on the results of a recent large multicenter study by the European Vasculitis Society (EUVAS). The draft of the author committee was revised by each contributor and subsequently distributed to 12 experts on 4 continents. After further revision the final document was returned for ratification and submitted for publication.
RESULTS/CONCLUSION: The current study results confirm the superiority of the diagnostic value of antigen-specific immunoassays compared to IIF. The current consensus recommendations support the primary use of PR3-ANCA and MPO-ANCA immunoassays for diagnostic evaluation of patients with AAV without the categorical need for additional IIF.
迄今为止，间接免疫荧光法（IIF）继之以针对蛋白酶3（PR3）或髓过氧化物酶（MPO）的抗原特异性检测，一直是检测抗中性粒细胞胞浆抗体（ANCA）的标准方法。用于诊断ANCA相关血管炎（AAV）的更灵敏且高度特异的PR3-ANCA和MPO-ANCA免疫检测方法的出现，引发了对当前推荐的用于ANCA检测的两阶段诊断策略的质疑。
介绍并讨论关于AAV中ANCA检测的新的国际共识建议。
本文介绍了基于欧洲血管炎协会（EUVAS）近期一项大型多中心研究结果制定的ANCA检测新指南。作者委员会的草案由每位贡献者修订，随后分发给四大洲的12位专家。经过进一步修订后，最终文件被退回以供批准并提交发表。
结果/结论：当前研究结果证实了抗原特异性免疫检测在诊断价值上优于IIF。当前的共识建议支持主要使用PR3-ANCA和MPO-ANCA免疫检测来对AAV患者进行诊断评估，而无需绝对需要额外的IIF。
