Cohen P, Guillevin L, Baril L, Lhote F, Noel L H, Lesavre P
Department of Internal Medicine, Hôpital Avicenne, Bobigny, France.
Clin Exp Rheumatol. 1995 Mar-Apr;13(2):193-8.
We retrospectively analyzed the significance of persistent ANCA positivity after clinical remission in 53 consecutive patients with histologically and/or angiographically proven polyarteritis nodosa (PAN), or Churg-Strauss syndrome (CSS) followed between 1981 and 1993.
ANCA were detected using an immunofluorescence assay and ELISA: Each patient met the American College of Rheumatology 1990 criteria for PAN or CSS. Clinical and biological evaluations were always essential factors in the decision to intensify therapy.
ANCA were initially present in 15 patients (28.3%): 3/26 (11.5%) with HBV-related PAN, 6/18 (33.3%) with PAN of unknown etiology and 6/9 (66.7%) with CSS. Five patients remained ANCA-positive after clinical remission: 3 with PAN (one of them relapsed) and 2 with CSS who both relapsed. Among the 12 patients who died during follow-up, only 1 (8.3%) was initially ANCA-positive. Fifteen of the 41 survivors (29.2%) were ANCA-positive.
Persistence of ANCA positivity in PAN and CSS may be a marker of an underlying disease process, but does not adequately reflect disease activity and, thus, in no case should be the only indication for therapeutic intensification.
我们回顾性分析了1981年至1993年间连续随访的53例经组织学和/或血管造影证实的结节性多动脉炎（PAN）或变应性肉芽肿性血管炎（CSS）患者临床缓解后持续ANCA阳性的意义。
采用免疫荧光法和酶联免疫吸附测定法检测ANCA：每位患者均符合美国风湿病学会1990年PAN或CSS的诊断标准。临床和生物学评估始终是决定强化治疗的关键因素。
15例患者（28.3%）最初检测到ANCA阳性：26例乙肝相关PAN患者中有3例（11.5%），18例病因不明的PAN患者中有6例（33.3%），9例CSS患者中有6例（66.7%）。5例患者临床缓解后仍ANCA阳性：3例PAN患者（其中1例复发），2例CSS患者均复发。在随访期间死亡的12例患者中，只有1例（8.3%）最初ANCA阳性。41例存活患者中有15例（29.2%）ANCA阳性。
PAN和CSS患者中ANCA阳性的持续存在可能是潜在疾病过程的一个标志，但不能充分反映疾病活动，因此，在任何情况下都不应是强化治疗的唯一指征。
