SLE患者检测血清ANCA的临床价值

目的 探讨抗中性粒细胞胞浆抗体（ANCA）在系统性红斑狼疮（SLE）患者中检测的临床意义.方法 通过间接免疫荧光法（IIF）检测57例SLE患者血清中的ANCA,对ANCA阳性血清采用免疫斑点法检测抗髓过氧化物酶（MPO）和蛋白酶3（PR3）抗体;同时以35例正常健康者作为对照组.回顾性分析SLE临床表现和实验室检查结果,SLE患者以SLE disease activity index（SLEDAI）分组（SLEDAI≥10为疾病活动组、〈10为疾病非活动组）,分析ANCA与其的相关性.结果 SLE患者中ANCA 阳性率为22.8%,其中核周型（pANCA）阳性12例,阳性率为 21.1%,胞浆型（cANCA）1例,阳性率为 1.7%,靶抗原均为非MPO、PR3;ANCA阳性组与ANCA阴性组SLE活动性存在显著性差异（P〈0.05）,ANCA阳性组患者的补体C3的下降、血沉（ESR）的增高、抗dsDNA抗体的阳性以及皮肤血管炎和肾脏损伤与ANCA阴性组比较,差异有统计学意义（P〈0.05）.结论 ANCA在SLE中有一定阳性检出率,对疾病活动性判断有一定的临床价值.

Clinical Value of ANCA Detection in Patients with Systemic Lupus Erythematosus

Objective To explore the diagnostic value of anti-neutrophil cytoplasmic antibody(ANCA) detection in patients with systemic lupus erythematosus(SLE).Methods The expression of serum ANCA in 57 samples of patients with SLE were tested by indirect immunofluorescence(IIF),myeloperoxidase(MPO) and protease 3(PR3) were detected by immune spots method when serum ANCA were positive.Simultaneously,35 normal healthy persons served as control group.We reviewed clinical manifestations and laboratory test results of SLE.Also,Divided patients into two groups follow SLE disease activity index(SLEDAI)(SLEDAI ≥10 as the disease activity group,SLEDAI<10 as inactivity group) and analysed their relevance.Results The positive rate of ANCA in SLE was 22.8%,in which peripheral-ANCA(pANCA)were positive in 12 patients and cytoplasmic-ANCA(cANCA) was positive in one case.The positive rate of pANCA was 21.1%.There was a remarkable difference(P<0.05) between ANCA-positive SLE patients and ANCA-negative group within the indexes of SLEDAI.The ANCA-positive group had higher titers of anti-dsDNA antibody,lower levels of complements(C3),higher erythrocyte sedimentation rate,skin vasculitis and kidney damage compared to ANCA negative patients(P<0.05).Conclusion The positive rate of ANCA in SLE patients is of substantial value for detection of SLE activity.