Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Cardiac Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Am J Med. 2022 Nov;135(11):1371-1377. doi: 10.1016/j.amjmed.2022.06.015. Epub 2022 Jul 9.
Antineutrophil cytoplasmic antibody (ANCA) has been reported in patients with infective endocarditis. Whether ANCA is associated with certain characteristics of infective endocarditis is unclear. The principal aim of this study is to investigate the clinical implications of ANCA in infective endocarditis and highlight the diagnostic challenge in ANCA-positive patients with infective endocarditis.
A retrospective study was conducted in a tertiary hospital in China from August 2012 to December 2021. Patients with a diagnosis of infective endocarditis and available ANCA results were included in the study. The clinical and pathological characteristics were compared between ANCA-positive and ANCA-negative patients.
A total of 237 patients were included. Forty three (18.1%) were ANCA-positive, predominantly c-ANCA/anti-PR3. Compared to ANCA-negative patients, ANCA-positive patients had longer disease duration (P = .004), more frequent purpura (P = .015), macrohematuria (P = .002), proteinuria (P = .043), acute kidney injury (P = .004), and rapidly progressive glomerulonephritis (P = .010). Histologic findings of 8 patients with infective endocarditis-associated glomerulonephritis were reviewed. Two ANCA-positive patients with infective endocarditis presented with pauci-immune necrotizing and crescentic glomerulonephritis. A total of 18.6% of ANCA-positive patients with infective endocarditis were misdiagnosed as ANCA-associated vasculitis.
ANCA is detected in a substantial proportion of patients with infective endocarditis. The presence of ANCA in infective endocarditis is associated with longer disease duration, more frequent purpura, and kidney involvement. ANCA-positive infective endocarditis may mimic ANCA-associated vasculitis, and the differential diagnosis is challenging. Whether ANCA is pathogenic in infective endocarditis-associated small vessel vasculitis requires further study.
抗中性粒细胞胞质抗体（ANCA）已在感染性心内膜炎患者中报道。ANCA 是否与感染性心内膜炎的某些特征相关尚不清楚。本研究的主要目的是探讨 ANCA 在感染性心内膜炎中的临床意义，并强调 ANCA 阳性感染性心内膜炎患者的诊断挑战。
在中国的一家三级医院进行了一项回顾性研究，时间为 2012 年 8 月至 2021 年 12 月。纳入了诊断为感染性心内膜炎且有可用 ANCA 结果的患者。比较了 ANCA 阳性和 ANCA 阴性患者的临床和病理特征。
共纳入 237 例患者。其中 43 例（18.1%）为 ANCA 阳性，主要为 c-ANCA/抗-PR3。与 ANCA 阴性患者相比，ANCA 阳性患者的疾病持续时间更长（P=0.004），更频繁出现紫癜（P=0.015）、肉眼血尿（P=0.002）、蛋白尿（P=0.043）、急性肾损伤（P=0.004）和快速进展性肾小球肾炎（P=0.010）。回顾性分析了 8 例感染性心内膜炎相关肾小球肾炎患者的组织学发现。两名 ANCA 阳性感染性心内膜炎患者表现为少免疫性坏死性和新月体性肾小球肾炎。18.6%的 ANCA 阳性感染性心内膜炎患者被误诊为 ANCA 相关性血管炎。
在相当一部分感染性心内膜炎患者中检测到 ANCA。感染性心内膜炎中存在 ANCA 与疾病持续时间较长、更频繁出现紫癜和肾脏受累有关。ANCA 阳性感染性心内膜炎可能类似于 ANCA 相关性血管炎，鉴别诊断具有挑战性。ANCA 在感染性心内膜炎相关小血管血管炎中的致病性需要进一步研究。
