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目的分析抗髓过氧化物酶(MPO)抗体阳性的韦格纳肉芽肿病(WG)患者的临床病理特点及其与传统的抗蛋白酶3(PR3)抗体阳性者之间的差异。方法89例WG患者经本院肾内科确诊,分析其临床病理资料并对比抗MPO抗体阳性和抗PR3抗体阳性的两组患者之间的差异。结果89例患者中54例抗MPO抗体阳性,34例抗PR3抗体阳性。抗MPO抗体阳性患者中男性所占的比例显著低于抗PR3抗体阳性者(男:女分别为23:31与24:10,P<0.05)。抗MPO抗体阳性的WG临床亦呈多器官受累的表现,其中关节痛、皮疹、眼、耳受累的发生率显著低于抗PR3抗体阳性者(分别为46.3%比70.6%,P<0.05;20.4%比44.1%,P<0.05;27.8%比58.8%,P<0.01和40.7%比67.6%,P<0.05);伯明翰血管炎活动度积分(BVAS)显著低于抗:PR3抗体阳性者(22.2±6.2比24.7±6.9,P<0.05);而在确诊时Scr增高的发生率则显著高于抗PR3抗体阳性者(81.5%比61.8%,P<0.05)。结论在国人的WG患者中,抗MPO抗体阳性者可能不占少数,它与抗PR3抗体阳性者临床表现有所不同。
Objective To analyze the clinicopathological features of patients with positive myeloproliferative granulomatosis (WG) with anti-myeloperoxidase (MPO) antibodies and their differences from the traditional anti-protease 3 (PR3) antibody positive patients. Methods Eighty-nine patients with WG were diagnosed as nephrologists in our hospital, and their clinicopathological data were analyzed. The differences between two groups of patients with anti-MPO antibody and anti-PR3 antibody were compared. Results Of the 89 patients, 54 were anti-MPO antibodies and 34 were anti-PR3 antibodies. The proportion of men in the anti-MPO antibody-positive patients was significantly lower than that in the anti-PR3 antibody-positive men and women (23:31 and 24:10, P <0.05, respectively). The incidence of multiple organ involvement in MPO-positive WG patients was also significantly lower than that in the anti-PR3 antibody-positive patients (46.3% vs 70.6%, respectively; P <0.05; 20.4 (44.2%, P <0.05; 27.8% vs. 58.8%, P <0.01 and 40.7% vs. 67.6%, P <0.05); BVAS was significantly lower in the Birmingham vasculitis group than in the anti-PR3 antibody positive group ± 6.2 vs 24.7 ± 6.9, P <0.05). However, the increased incidence of Scr at the time of diagnosis was significantly higher than that of patients with anti-PR3 antibody (81.5% vs. 61.8%, P <0.05). Conclusions Among the Chinese patients with WG, anti-MPO antibody positive may not account for a minority, its anti-PR3 antibody positive clinical manifestations are different.