Davenport A, Lock R J, Wallington T B, Feest T G
Richard Bright Renal Unit, Southmead Hospital, Bristol, UK.
Q J Med. 1994 May;87(5):291-9.
We assessed the use of a standardized antineutrophil cytoplasm antibody (ANCA) test in diagnosing Wegener's granulomatosis (WG), microscopic polyarteritis (mPA) and systemic vasculitis (SV). All samples (n = 779) tested for ANCA at our laboratory were identified, and clinical information was obtained for 783/779 patients by questionnaire, and by visits where necessary. The combined prevalence of WG/mPA/SV was 123/738 (17%). The ANCA test was positive in 48/68 WG patients (71%; 38 cANCA, 10 pANCA), 22/43 mPA patients (51%; 12 cANCA, 10 pANCA) and 3/12 SV patients (25%). WG and mPA patients in remission had similar frequencies of positive ANCA to those with active disease. The sensitivity and specificity for WG (71% and 80%) and mPA (51% and 80%) were lower than previously reported. In this high-prevalence population, the overall (WG/mPA/SV) positive predictive value was only 40%, and the sensitivity 59%. Only 29% of positive tests were from patients with active disease. Overall, 78% of test results gave a 'true' prediction. On this basis, a diagnosis of necrotizing vasculitis (WG/mPA/SV) can be neither made nor refuted by ANCA test alone.
我们评估了标准化抗中性粒细胞胞浆抗体（ANCA）检测在诊断韦格纳肉芽肿（WG）、显微镜下多血管炎（mPA）和系统性血管炎（SV）中的应用。对在我们实验室进行ANCA检测的所有样本（n = 779）进行了识别，并通过问卷调查以及在必要时进行走访，获取了783/779例患者的临床信息。WG/mPA/SV的合并患病率为123/738（17%）。ANCA检测在68例WG患者中有48例呈阳性（71%；38例胞浆型ANCA，10例核周型ANCA），43例mPA患者中有22例呈阳性（51%；12例胞浆型ANCA，10例核周型ANCA），12例SV患者中有3例呈阳性（25%）。处于缓解期的WG和mPA患者ANCA阳性频率与疾病活动期患者相似。WG（71%和80%）和mPA（51%和80%）的敏感性和特异性低于先前报道。在这个高患病率人群中，总体（WG/mPA/SV）阳性预测值仅为40%，敏感性为59%。仅29%的阳性检测来自疾病活动期患者。总体而言，78%的检测结果给出了“真实”预测。在此基础上，仅靠ANCA检测既不能确诊也不能排除坏死性血管炎（WG/mPA/SV）。
