抗中性粒细胞胞浆抗体在狼疮性肾炎患者中的临床意义

目的 分析抗中性粒细胞胞浆抗体（ANCA）阳性的狼疮性肾炎（LN）患者的临床特点，探讨ANCA检测的临床意义。方法 选择26l例LN患者。使用ELISA法将其分为ANCA阳性和ANCA阴性两组，分别为53例和208例。回顾性分析所有患者的一般情况、诊断标准数、狼疮活动度（SLE-DAI）评分、症状、体征、并发症和各种常规、生化、免疫学检查以及病理结果、随访结果。结果 ANCA阳性组中浆膜炎（75．5％）、急性肾衰（64．2％）、心肌炎（30．2％）、神经精神症状（26．4％）、肺出血（7．5％）明显高于ANCA阴性组（P〈0．05）；同时ANCA阳性组与阴性组比较，在SLE-DAI评分、诊断标准数、血沉、血红蛋白（≤11g／dl）、抗Sm、补体C3、γ球蛋白、IgG方面差别有统计学意义（P〈0．05）；ANCA阳性组中病理以Ⅳ型LN（67．9％）为主，慢性指数（CI）、新月体形成、肾小管萎缩、微血栓与ANCA阴性组比较有统计学意义（P〈0．05）；预后方面ANCA阳性组死亡率高于ANCA阴性组（P〈0．05）。结论 ANCA的定性分析有助于判断LN患者病情活动程度及预后。

Clinical significance of antineutrophil cytoplasmic antibodies in patients with lupus nephritis

OBJECTIVE: To analyze the clinical features of patients with lupus nephritis positive for antineutrophil cytoplasmic antibodies (ANCA) and explore the clinical implications of ANCA detection. METHODS: Totally 261 patients with lupus nephritis were enrolled in this study, including 53 ANCA-positive and 208 ANCA-negative ones. The clinical data of the patients pertaining to the disease history, physical examination, laboratory examinations and pathological inspection were retrospectively analyzed. RESULTS: Compared with patients negative for ANCA, the ANCA-positive patients had significantly higher incidence of serositis (75.5%), acute renal failure (64.2%), myocarditis (30.2%), neuropsychiatric involvement (26.4%) and lung hemorrhage (7.5%)(P<0.05). Significant differences were also found between the two groups in SLE disease active index (SLE-DAI), number of the diagnostic criteria, erythrocyte sedimentation rate (ESR), anemia, anti-Sm antibodies, and serum complement C(3). Most patients positive for ANCA (67.9%) had type IV lupus nephritis with more crescent formation, renal tubular atrophy, hyaline thrombi, and higher mortality rate as well than the negative patients. CONCLUSION: ANCA detection may benefit the estimation of the disease severity and prognostic evaluation of lupus nephritis.