探讨ANCA在嗜酸性肉芽肿性多血管炎分类中的价值  

Explore the value of ANCA in the classification of eosinophilic granulomatous polyangiitis

作　　者：刘怡彤 程蕴琦 彭敏[1] 张婷[1] 杨沛然 施举红[1] LIU Yitong;CHENG Yunqi;PENG Min;ZHANG Ting;YANG Peiran;SHI Juhong(Department of Pulmonary and Critical Care Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;State Key Laboratory of Respiratory Health and Multimorbidity,Department of Physiology,Institute of Basic Medical Sciences,Chinese Academy of Medical Sciences,School of Basic Medicine Peking Union Medical College,Beijing 100005)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院呼吸与危重症医学科,北京100730 [2]中国医学科学院北京协和医学院,北京100730 [3]呼吸和共病全国重点实验室,生理学系,中国医学科学院基础医学研究所,北京协和医学院基础学院,北京100005

出　　处：《中华临床免疫和变态反应杂志》2024年第2期110-118,共9页Chinese Journal of Allergy & Clinical Immunology

基　　金：国家重点研发计划常见多发病防治研究(2023YFC2507204);中央高水平医院临床科研业务费(2022-PUMCH-C-017)。

摘　　要：目的嗜酸性肉芽肿性多血管炎(eosinophilic granulomatosis with polyangiitis,EGPA)中以血管炎为主要特征和以嗜酸性粒细胞浸润为主要特征的两种亚型分类标准尚未明确,本研究探讨EGPA两种亚型的准确、简明分类方式。方法回顾性收集2000年1月—2023年11月北京协和医院呼吸内科、全科医学科、风湿免疫科等多科确诊的EGPA患者临床资料,将患者根据单纯抗中性粒细胞胞浆抗体(antineutrophil cytoplasmic antibodies,ANCA)、ANCA与组织病理活检结果相结合以及MIRRA标准三种分类方法分为不同的阳性组和阴性组,分析患者的临床特征。结果共纳入245例患者。根据ANCA结果分类时,阳性组51例,阴性组194例,相较于阴性组,阳性组患者的年龄(60.9比55.4)、NEUT%(59.12比51.87)、PLT(312.94比264.64)、ESR(55.40比27.62)、CRP(46.51比23.57)均较高,上述指标均达显著统计学意义;阳性组肾脏系统(47.1%比25.8%)和神经系统(72.5%比58.2%)的受累比例也显著高于阴性组。根据ANCA结果和组织病理活检结果分类时,阳性组88例,阴性组157例,两组间的分析结果与第一种分类方法一致。根据MIRRA标准分类时,MIRRA标准组患者161例,MIRRA非标准组患者84例,MIRRA标准组的NEUT%(55.39比49.58)显著高于MIRRA非标准组,而LY%(18.57比21.30)和HGB(128.80比136.36)显著低于MIRRA非标准组。结论根据ANCA结果可将EGPA患者分为血管炎亚型和嗜酸性粒细胞浸润亚型;尽管ANCA联合组织病理活检结果也可明确区分血管炎亚型与嗜酸性粒细胞浸润亚型,但由于病理活检存在风险,需根据患者的具体情况进行个体化评估;而MIRRA标准不能准确区分两类亚型。Objective The aim of this study was to investigate the most accurate and concise classification criteria for distinguishing between the two subtypes of EGPA,characterized by vasculitis and eosinophilic infiltration,among ANCA alone,ANCA combined with pathological results,and MIRRA criteria since the classification criteria for these subtypes have not yet been clarified.Methods The present study retrospectively analyzed patients diagnosed with EGPA diagnosed in the Department of Pulmonary and Critical Care Medicine,Department of General Internal Medicine,Department of Rheumatology at Peking Union Medical College Hospital from January 2000 to November 2023.Based on the aforementioned three classification indexes,patients were divided into different positive and negative groups,and a comparative analysis of their clinical characteristics was conducted.Results A total of 245 patients were included.When classified based on ANCA results,there were 51 patients in the positive group and 194 in the negative group.The positive group exhibited higher values in terms of age(60.9 vs 55.4),NEUT%(59.12 vs 51.87),PLT(312.94 vs 264.64),ESR(55.40 vs 27.62),and CRP(46.51 vs 23.57)compared to the negative group,and all of the above indicators reached statistical significance.The involvement of the renal system(47.1%vs 25.8%)and nervous system(72.5%vs 58.2%)exhibited significantly higher prevalence in the positive group.The positive group consisted of 88 cases,while the negative group included 157 cases,when classified based on ANCA and pathological results.The findings between these two groups were consistent with the initial results.When classified according to the MIRRA criteria,there were 161 patients in the compliant group and 84 patients in the non-compliant group,and the NEUT%(55.39 vs 49.58)was significantly higher in the compliant group than in the non-compliant group,and the LY%(18.57 vs 21.30)and HGB(128.80 vs 136.36)were significantly lower than in the non-compliant group.Conclusions Patients with EGPA can be classified i

关 键 词：嗜酸性肉芽肿性多血管炎 抗中性粒细胞胞浆抗体 MIRRA研究 

分 类 号：R593.2[医药卫生—内科学]