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目的:探讨系统性红斑狼疮(Systemic Lupus Erythematosus,SLE)患者抗中性粒细胞胞浆抗体(Anti-neutrophil Cytoplasmic Antibodies,ANCA)与肾炎及其他临床表现和实验室检查的相关性及其意义。方法:采用前瞻性研究收集77例系统性红斑狼疮患者,用间接免疫荧光法(IIF)检测患者血清ANCA、ELISA法检测ANCA抗原,检测其他免疫学指标如抗核抗体、抗dsDNA抗体等。结果:77例SLE患者中ANCA阳性28(36.4%)例,ANCA阳性组浆膜炎、肾损害、神经精神症状、皮肤血管炎、抗dsDNA抗体阳性、抗Sm抗体阳性、补体下降以及血清IgG升高的发生率明显高于阴性组(P<0.05)。52例LN患者中,25例(48.1%)ANCA阳性,其中P-ANCA阳性者22例(88%),3例(12%)为a-ANCA均出现在RPGN,无一例出现c-ANCA。非LN组25例患者中,仅3例(12%)p-ANCA阳性,且均为抗-MPO。正常对照组无一例ANCA阳性。77例SLE患者中,14例(18.2%)为抗-MPO;13例(16.9%)为抗LF,且只见于DPGN、FPGN和RPGN伴有新月体形成者;10例(13%)为抗-CG,但在非狼疮肾炎患者未检测到抗-LF及抗-CG。在各种临床表现中,抗-MPO与肾脏和皮肤表现有关;而抗-LF与肾脏、关节炎及浆膜炎有关;抗-CG可见于各种临床表现。结论:ANCA可作为评价SLE疾病及鉴别血管炎和狼疮肾炎的一个重要指标。
Objective: To investigate the relationship between anti-neutrophil cytoplasmic antibody (ANCA) and nephritis and other clinical manifestations and laboratory tests in patients with systemic lupus erythematosus (SLE) and its significance. METHODS: A total of 77 patients with systemic lupus erythematosus (SLE) were enrolled in the prospective study. Serum ANCA was detected by indirect immunofluorescence (IFA), ANCA antigen by ELISA, and other immunological parameters such as anti-nuclear antibody and anti-dsDNA antibody were detected. RESULTS: The ANCA positive in 77 SLE patients was serosa, renal damage, neuropsychiatric symptoms, cutaneous vasculitis, anti-dsDNA antibody positive, anti-Sm antibody positive, complement reduction and serum IgG l High incidence was significantly higher than the negative group (P <0.05). Of the 52 patients with LN, 25 (48.1%) had ANCA positive, of which 22 (88%) had P-ANCA positive and 3 (12%) had a-ANCA and all had RPGN. None of them had c-ANCA. Of 25 non-LN patients, only 3 (12%) had p-ANCA positive and all were anti-MPO. None of the normal controls had ANCA positive. Of the 77 SLE patients, 14 (18.2%) were anti-MPO; 13 (16.9%) were resistant to LF and were found only in DPGN; FPGN and RPGN were associated with crescent formation; 10 (13%) were Anti-CG but not anti-LF and anti-CG in non-lupus nephritis patients. In various clinical manifestations, anti-MPO is associated with kidney and skin manifestations; whereas anti-LF is associated with kidney, arthritis, and serositis; anti-CG is seen in a variety of clinical manifestations. Conclusion: ANCA can be used as an important index for evaluating SLE disease and identifying vasculitis and lupus nephritis.