丙基硫氧嘧啶引起抗中性粒细胞胞质抗体相关小血管炎并非药物性狼疮  

Vasculitis associated with propylthiouracil-induced antineutrophil cytoplasmic antibody is not drug induced lupus

作　　者：高莹[1] 赵明辉[2] 郭晓蕙[1] 高妍[1] 

机构地区：[1]北京大学第一医院内分泌科,北京100034 [2]北京大学第一医院肾内科,北京100034

出　　处：《基础医学与临床》2005年第9期829-833,共5页Basic and Clinical Medicine

摘　　要：目的检测药物性狼疮(DIL)的血清学标志抗组蛋白抗体在抗中性粒细胞胞质抗体(ANCA)阳性的甲亢患者中的阳性率,并探讨丙基硫氧嘧啶(PTU)引起的ANCA相关小血管炎与DIL的关系。方法以34例ANCA阳性的原发甲亢患者为研究对象,其中18例确诊为PTU引起的ANCA相关小血管炎;同时选取10例原发性ANCA相关小血管炎患者及10例初发未治疗的甲亢患者为对照,应用ELISA法检测抗组蛋白抗体。将我院确诊的PTU引起的AN-CA相关小血管炎患者的临床资料与文献中抗甲状腺药物引起的DIL相比较。结果所有原发性ANCA相关小血管炎的患者及初发未治疗的甲亢患者均未检测到抗组蛋白抗体;在34例PTU引起的ANCA阳性患者中仅1例(2·9%)抗组蛋白抗体阳性,此例患者为18例有血管炎临床表现中的1例(5·6%)。PTU引起的ANCA相关小血管炎不同于DIL,寡免疫复合物的坏死性新月体性肾炎及肺出血为前者的特征性表现。结论PTU引起的ANCA相关小血管炎患者中抗组蛋白抗体的低发生率提示其与DIL可能不完全相同。Objective To detect antihistone antibodies in serum of patients with positive ANCA induced by PTU and to study the relationship between ANCA-associated vasculitis and DIL. Methods Serum samples were collected from 34 ANCA positive patients treated with antithyroid drugs, 10 patients with primary systemic vasculitis and ten untreated patients with hyperthyroidism. Eighteen in the thirty-four patients had clinical ANCA-associated vasculitis induced by PTU. Clinical features of PTU induced ANCA-associated vasculitis were compared with those of DIL reviewing literature. Antihistone IgG antibody was detected by ELISAs. Results Antihistone IgG antibody was not found in serum from both patients with primary vasculitis and untreated patients with hyperthyroidism. In 34 ANCA positive patients, only one in eighteen serum samples from patients （5.6%） with clinical vasculitis was antihistone IgG antibody positive. Pauciimmune necrotizing and crescentic glomerulonephritis and pulmonary hemorrhage were the features of ANCA associated vasculitis, which were rare in DIL. Conclusion ANCA-associated vasculitis induced by PTU might be different from DIL.

关 键 词：抗甲状腺药物 抗中性粒细胞胞质抗体 血管炎 抗组蛋白抗体 药物性狼疮 

分 类 号：R595.3[医药卫生—内科学]