Schönermarck Ulf, Hellmich Bernhard, Csernok Elena
Medizinische Klinik und Poliklinik IV, Nephrologisches Zentrum, LMU Klinikum, Campus Großhadern, LMU München, Deutschland.
Klinik für Innere Medizin, Rheumatologie, Pneumologie, Nephrologie und Diabetologie, Medius Kliniken, Akademisches Lehrkrankenhaus der Universität Tübingen, Kirchheim-Teck, Deutschland.
Z Rheumatol. 2024 May;83(4):283-296. doi: 10.1007/s00393-024-01494-y. Epub 2024 Apr 8.
The diagnosis of systemic vasculitis (SV) is a major clinical challenge due to the very different forms of presentation and requires an interdisciplinary approach. Targeted laboratory diagnostics support making the diagnosis, differential diagnosis and classification and are also a key component in the detection of active organ manifestations and treatment complications. The basic laboratory tests include the erythrocyte sedimentation rate (ESR), C‑reactive protein (CRP), blood count, serum creatinine, urinalysis, specific autoantibodies, complement, immunoglobulins, cryoglobulins and hepatitis B and C serology. Antineutrophil cytoplasmic autoantibodies (ANCA), antiglomerular basement membrane antibodies (anti-GBM antibodies) and anti-C1q antibodies are valuable laboratory markers for the diagnosis of the various forms of small vessel vasculitis. There are no specific laboratory tests for the diagnosis of medium and large vessel vasculitis. Despite advances in our understanding of the pathogenesis of vasculitis, no biomarkers have yet been identified that can be reliably used to guide treatment or that are useful in distinguishing vasculitis from other inflammatory diseases such as infections or treatment complications.
由于系统性血管炎(SV)的表现形式差异很大,其诊断是一项重大的临床挑战,需要采用多学科方法。针对性的实验室诊断有助于进行诊断、鉴别诊断和分类,也是检测活动性器官表现和治疗并发症的关键组成部分。基本实验室检查包括红细胞沉降率(ESR)、C反应蛋白(CRP)、血常规、血清肌酐、尿液分析、特异性自身抗体、补体、免疫球蛋白、冷球蛋白以及乙肝和丙肝血清学检查。抗中性粒细胞胞浆自身抗体(ANCA)、抗肾小球基底膜抗体(抗GBM抗体)和抗C1q抗体是诊断各种形式小血管炎的重要实验室标志物。目前尚无诊断中、大血管炎的特异性实验室检查。尽管我们对血管炎发病机制的认识有所进展,但尚未发现可可靠用于指导治疗或有助于将血管炎与其他炎症性疾病(如感染或治疗并发症)相鉴别的生物标志物。