Westman K W, Bygren P G, Eilert I, Wiik A, Wieslander J
Department of Nephrology, University Hospital, Lund, Sweden.
Nephrol Dial Transplant. 1997 Sep;12(9):1863-8. doi: 10.1093/ndt/12.9.1863.
Pulmonary renal syndrome is encountered in several diseases such as Goodpasture's syndrome, antineutrophil cytoplasmic antibody (ANCA) associated systemic vasculitis, systemic lupus erythematosus (SLE) and infection-associated or drug-induced glomerulonephritis. To preserve organ function it is of vital importance to make the correct diagnosis and institute adequate therapy early, in the acute phase.
An enzyme-linked immunosorbent assay (ELISA), specially designed as a rapid screening assay for antiglomerular basement membrane (anti-GBM) antibody, proteinase-3 (PR3-) ANCA and myeloperoxidase-(MPO-) ANCA were evaluated from 1060 serum samples drawn from patients with clinically suspected pulmonary renal syndrome or rapidly progressive glomerulonephritis (RPGN).
Of the 1060 serum samples, 142 were positive for anti-GBM antibody (n = 19), PR3-ANCA (n = 60), or MPO-ANCA (n = 73). Of the 142 samples, 10 were double positive. Reanalysis of positive sera with a quantitative ELISA yielded results manifesting good correlation with those of the the rapid screening assay. Of 918 sera found to be negative in the rapid screening assay, 105 were also tested with IIF, 11 being found to be positive. However, these 11 sera manifested no specificity for PR3 or MPO, but some were specific for bactericidal/permeability-increasing proteins, lactoferrin or elastase ANCAs. Two of the patients whose sera yielded negative results in the rapid assay had systemic vasculitis.
The ELISA thus detects the true antibodies to PR3, MPO, and GBM, whereas IIF detects additional specificities. The findings suggest the rapid assay results to be of high positive predictive value, and the assay to be of high diagnostic specificity and sensitivity and thus useful in the diagnostic workup in suspected cases of RPGN or pulmonary renal syndrome.
肺肾综合征可见于多种疾病，如古德帕斯丘综合征、抗中性粒细胞胞浆抗体（ANCA）相关系统性血管炎、系统性红斑狼疮（SLE）以及感染相关或药物性肾小球肾炎。为保护器官功能，在急性期早期做出正确诊断并开始适当治疗至关重要。
对从临床疑似肺肾综合征或急进性肾小球肾炎（RPGN）患者采集的1060份血清样本，评估一种专门设计用于抗肾小球基底膜（抗GBM）抗体、蛋白酶3（PR3）-ANCA和髓过氧化物酶（MPO）-ANCA快速筛查的酶联免疫吸附测定（ELISA）。
在1060份血清样本中，142份抗GBM抗体（n = 19）、PR3-ANCA（n = 60）或MPO-ANCA（n = 73）呈阳性。在这142份样本中，10份为双阳性。用定量ELISA对阳性血清进行重新分析，结果与快速筛查测定结果显示出良好的相关性。在快速筛查测定中发现918份血清为阴性，其中105份也用间接免疫荧光法（IIF）检测，11份呈阳性。然而，这11份血清对PR3或MPO无特异性，但有些对杀菌/通透性增加蛋白、乳铁蛋白或弹性蛋白酶ANCA具有特异性。快速测定血清结果为阴性的两名患者患有系统性血管炎。
ELISA可检测到针对PR3、MPO和GBM的真正抗体，而IIF可检测到其他特异性抗体。研究结果表明快速测定结果具有较高的阳性预测价值，该测定具有较高的诊断特异性和敏感性，因此在疑似RPGN或肺肾综合征病例的诊断检查中有用。
