抗中性粒细胞胞浆抗体及其靶抗原检测与肾脏疾病的临床研究

目的 评价抗中性粒细胞胞浆抗体（ANCA）与肾脏疾病关联及其诊断、随访价值，初步探讨不典型ANCA（A-ANCA）的临床意义。方法 以IIF法、ELISA法联合检测ANCA及其靶抗原。结果 27例ANCA阳性：16例原发性系统性血管炎（4例C-ANCA∧ /PR3-ANCA∧ ，7例P-ANCA∧ /MPO-ANCA∧ ，4例P-ANCA∧ /抗原不明，1例C-ANCA∧ /抗原不明），2例紫癜肾（P-ANCA∧ /抗原不明），3例SLE（P-ANCA∧ /LF-ANCA∧ ），此外A-ANCA6例。结论 PR3-ANCA、MPO-ANCA为原发性系统性血管炎重要诊断、分型和随访指标，LF-ANCA与SLE肾脏损害无关联，A-ANCA检出于自身免疫性疾病，较多肝、肾间质受累。

Study on correlationbetween Anti-neutrophilic cytoplasmic antibodies and renal diseases

Objective To evaluate the correlation between anti-neutrophilic cytoplasmic antibodies (ANCAs)and renal diseases, and its significance in diagnosis and follow-up study. Methods ANCAs and the specific antigenswere detected by indirect immunofiuorescence (IIF) combined with ELISA. Results 27 cases presented positive ANCAs, including 16 primary systemic vasculitis (4 with C-ANCA+/PR3-ANCA+ , 7 with P-ANCA+/MPO-ANCA+ ,4 with P-ANCA+ and 1 with C-CNCA+ but antigens unknown), 2 HSP nephritis (P-ANCA+ but antigens unknown), 3 LN (P-ANCA+/LF-ANCA+ ), and 6 atypieal-ANCA+ cases in MCTD, RA, SS, etc. Conclusion Thevalue of IIF-ANCA can be greatly increased by the addition of antigen-specific ELISA. ANCA should be the most important diagnostic marker of WG and MPA, as well as the reference marker in follow-up. Its titer is in concordancewith disease activity, while the effect of LF-ANCA is unknown yet. As detected in other connective tissue diseases,atypical-ANCA may participate in immune modulation also as an autoimmune antibody. (Shanghai Med J, 2001,24:71-74)