Hachulla E, Hatron P Y, Brouillard M, Cesbron J Y, Reumaux D, Devulder B
Service de médecine interne, Hôpital Claude-Huriez, CHRU de Lille, France.
Rev Med Interne. 1994 May;15(6):381-6. doi: 10.1016/s0248-8663(05)81452-3.
The diagnostic value of c-ANCA as a specific marker of systemic vasculitis (particularly Wegener's granulomatosis) is well established. The prognostic value of c-ANCA for determining disease activity is controversial. We have prospectively studied in ten patients with systemic vasculitis over a mean period of 34 months (extreme 2-61 months). All patients had c-ANCA at the moment of the diagnosis: four patients had high titer of c-ANCA all over the period study; three clinical and biological exacerbations of the disease was observed without variation of the c-ANCA titer. In four patients c-ANCA disappeared within 6 months after the beginning of the treatment correlated with disease activity. Sometimes a rise of c-ANCA titer was observed with or without disease activity. In one case c-ANCA titer had a serrated evolution. The sensitivity and the specificity of the c-ANCA for disease activity in the ten studied patients were respectively 1 and 0.28. In patients with systemic vasculitis and c-ANCA at the time of the diagnosis, variation in c-ANCA titer alone is of limited prognostic value for predicting disease course.
c-ANCA作为系统性血管炎（特别是韦格纳肉芽肿病）的特异性标志物，其诊断价值已得到充分确立。c-ANCA对确定疾病活动度的预后价值存在争议。我们对10例系统性血管炎患者进行了前瞻性研究，平均观察期为34个月（范围2 - 61个月）。所有患者在诊断时均有c-ANCA：4例患者在整个研究期间c-ANCA均为高滴度；观察到3次疾病的临床和生物学加重，而c-ANCA滴度无变化。4例患者在治疗开始后6个月内c-ANCA消失，这与疾病活动度相关。有时，无论疾病是否活动，均可观察到c-ANCA滴度升高。有1例患者c-ANCA滴度呈锯齿状变化。在这10例研究患者中，c-ANCA对疾病活动度的敏感性和特异性分别为1和0.28。对于诊断时患有系统性血管炎且有c-ANCA的患者，仅c-ANCA滴度变化对预测疾病进程的预后价值有限。
