抗蛋白酶-3抗体在韦格纳肉芽肿病和其他血管炎中的临床应用研究  

Clinical application of antiproteinase 3 antibodies in Wegener's granulomatosis and other vasculitis patients

作　　者：王彩虹[1] 李小峰[1] 胡学芳[1] 吕志勤[1] 张琳[1] 王来远[1] 

机构地区：[1]山西医科大学第二医院风湿科,太原030001

出　　处：《中华风湿病学杂志》2006年第12期738-742,共5页Chinese Journal of Rheumatology

基　　金：山西省高校科技研究开发基金资助项目(2001-10)

摘　　要：目的探讨抗蛋白酶-3(PR3)抗体在韦格纳肉芽肿病(WG)和其他血管炎患者中的表达和临床意义。方法选取2001年3月至2006年7月山西医科大学第二医院确诊的住院患者576例。系统性血管炎组111例,其中9例WG(包含21份跟踪随访血清)；结缔组织病(CTD)组403例；各型肾小球疾病患者62例及健康对照30名,均采用酶联免疫吸附试验(ELISA)检测抗PR3抗体、抗髓过氧化物酶(MPO)抗体；采用间接免疫荧光法(IIF)检测抗中性粒细胞胞质抗体(ANCA),观察抗PR3与ANCA在WG和其他血管炎中的阳性率,且追踪WG治疗前后抗PR3吸光度值和ANCA的滴度变化。结果588例血清中抗PR3抗体阳性23例,分别为WG 15例(15/21,71．4％)；系统性红斑狼疮(SLE)6例(6/213,2．8％)：类风湿关节炎(RA)1例(1/135,0．7％)；混合结缔组织病(MCTD)1例。大动脉炎、白塞病,过敏性紫癜等常见的原发性系统性血管炎、肾病组、健康对照组未发现抗PR3抗体阳性。抗PR3抗体和胞质型ANCA(cANCA)在WG中阳性率最高,差异有统计学意义(P＜0．05)。抗PR3对WG诊断的敏感性71．42％,特异性98．58％。联合应用抗PR3与cANCA诊断WG的敏感性61．90％,特异性99．82％。抗PR3吸光度值、ANCA的滴度及伯明翰血管活动度评分(BVAS)随治疗好转下降。结论抗PR3抗体是诊断WG的一种敏感、特异标记抗体,抗PR3抗体和ANCA同时在临床应用,有利于WC和其他系统性血管炎的早期诊断和鉴别诊断。抗PR3抗体还可作为临床疗效观察指标。Objective To investgate prevalence and clinical significance of antiproteinase 3 （PR3） antibodies in Wegener＇s granulomatosis （WG） and other vasculitis patients. Methods One hundred and eleven systemic vasculitis patients with WG （9 cases, including 21 serums of tracking WG patients） and other systemic vasculitis （102 cases）, 403 secondnary vasculitis CTD （SLE 213 cases, RA 135 cases）, nephritis 62 cases, 30 healthy subjects were examined for anti-PR3 and anti-MPO antibody by enzyme-linked immunosorbent assay （ELISA） and ANCA by indirect immunofluorescence （IIF） was performed. Result Anti-PR3 positive were 23 in 588 serums of patients. The prevalence of anti-PR3 positive was WG （16/21, 71.4 %）, other systemic vasculitis were not found anti-PR3, SLE （6/213, 2.8%）, RA （1/135, 0.7%）. In particular, the prevalence of anti-PR3 and cANCA with WG tended to be higher in the patients with other systemic and secondnary vasculitis （P〈0.05）. The sensitivity and specificity of anti-PR3 for diagnosis of WG were 71.42% and 98.58%. The sensitivity and specificity of combination anti-PR3 and cANCA were 61.90% and 99.82%. Anti-PR3 and cANCA are associated with treament of WG. Conclusion Anti-PR3 antibody has high specificity for diagnosis of RA. Detection of anti-PR3 and cANCA at the same time can improve the specificity considerably. As sensitive markers of WG, anti-PR3 antibody may be useful for diagonosis and early treament. Anti-PR3 also may be useful for activity and relapse of WG.

关 键 词：抗蛋白酶-3抗体 韦格纳肉芽肿病 血管炎 

分 类 号：R593.9[医药卫生—内科学]