抗中性粒细胞抗体在血栓闭塞性脉管炎中的临床应用  

Clinical application of antineutrophil cytoplasmic antibodies on thromboangiitis obliterans(buerger's disease)

作　　者：张伟[1] 赖俊谕[1] 代远斌[1] 

机构地区：[1]重庆医科大学附属第一医院血管外科,重庆400016

出　　处：《重庆医科大学学报》2010年第3期421-424,共4页Journal of Chongqing Medical University

摘　　要：目的:探索抗中性粒细胞胞浆抗体(Antineutrophil cytoplasmic antibody,ANCA)及其特异性抗原在血栓闭塞性脉管炎(Thromboangiitis obliterans,TAO)中的表达。方法:TAO组23例,动脉硬化闭塞组(Arteriosclerosis obliterans,ASO)25例,健康组25例。采用间接免疫荧光法(Endirect immunofluorescence,IIF)检测3组中ANCA。用酶联免疫吸附法(Enzyme-linked-immunosorbentassay,ELISA)检测TAO组和健康组ANCA抗蛋白酶3(PR3)、髓过氧化物酶(MPO)、人白细胞弹性蛋白酶(HLE)、乳铁蛋白酶(LF)、组织蛋白酶G(CG)、杀菌/渗透性增高蛋白(BPI)抗体。结果:(1)23例TAO组患者中有12例ANCA阳性,检测率为52.2%。25例ASO组患者有1例ANCA阳性,检测率4%。健康组未检测出ANCA阳性。(2)TAO组重度患者ANCA的临床检出率(66.7%;10/15)及ANCA滴度均要高于中度患者(25%;2/8)。(3)12例ANCA阳性血清中有5例抗髓过氧化物酶(MPO)抗体为阳性,有3例抗乳铁蛋白酶(LF)抗体为阳性,1例抗人白细胞弹性蛋白酶(HLE)抗体为阳性,1例抗杀菌/渗透性增高蛋白(BPI)抗体为阳性,抗蛋白酶3(PR3)抗体,抗组织蛋白酶G(CG)抗体均为阴性。(4)4种阳性抗体均发现于严重血栓闭塞性脉管炎患者中。结论:ANCA的检测率和抗体水平与疾病的严重程度有关,ANCA的检测对临床血栓闭塞性脉管炎是1个有效的血清学检查。Objective：To investigate the presence of Anti-Neutrophil Cytoplasmic Antibodies（ANCA） and their specific antigens in the patients with thromboangiitis obliterans（Buerger＇s disease,TAO）.Methods：The TAO group includes 23 patients.The arteriosclerosis obliterans（ASO） group includs 25 pantients and the control group is health group includs 25 volunteers.Serum samples were investigated for ANCA prevalence by indirect immunofluorescent technique in TAO group,ASOgroup and health group.the reactivity to proteinase 3（PR3）,myeloperoxidase（MPO）,cathepsin G（CG）,bactericidal/permesbility-increasing protein（BPI）,elastase（HLE） and lactoferrin（LF） was measured by ELISA in TAO group and health group.Results：（1） There are 13 of 23 patients with TAO who are tested ANCA positive by indirect immunofluorescence,the ANCA prevalence is 52.2%.Only one patient is pANCA positive among 25 patients with ASO,the prevalence is 4%,and no ANCA are found in healthy controls.（2） ANCA were predominantly found in group II（66.7%;12/18） compared to group I（33.3%;3/9） and the levels of the titre of ANCA in the group II was higher than group I.（3） Only five of 12 ANCA-positive sera reacted with MPO,three of the twelve reacted with LF,one serum is HLE positive and one is BPI positive.No serum reacted with PR3 and CG.（4） Anti-MPO,anti-LF,anti-BPI and anti-HLE autoantibodies were found only in the severe group.Conclusion：The prevalence of ANCA and levels of Anti-MPO,anti-LF,anti-BPI and anti-HLE correlated with disease severity.Therefore,detection of ANCA can be a helpful serological test for the diagnosis of thromboangiitis obliterans.

关 键 词：抗中性粒细胞浆抗体 血栓闭塞性脉管炎 抗原 

分 类 号：R36[医药卫生—病理学] R392[医药卫生—基础医学]