抗中性粒细胞胞浆抗体在肾小球疾病中的检测及临床意义  

Test and importance of anti-neutrophil cytoplasmic antibody in glomerular diseases

作　　者：李桂英[1] 白宝银[1] 路学文[2] 

机构地区：[1]邯郸医学高等专科学校附属医院肾内科,河北邯郸056000 [2]河北医科大学第二医院泌尿内科,河北石家庄050000

出　　处：《临床荟萃》2003年第4期186-188,共3页Clinical Focus

摘　　要：目的　观察抗中性粒细胞胞浆抗体 (ANCA)在不同肾小球疾病中的发生情况、间接免疫荧光模式和靶抗原特点 ,并初步探讨ANCA在肾小球疾病中的临床意义。方法　用间接免疫荧光 (IIF ANCA)法测定 15 0例健康供血员和 2 5 2例各种原、继发肾小球疾病患者的血清 ,阳性者 (≥ 1∶2 0 )进一步检测蛋白酶 3(PR3)、髓过氧化物酶 (MPO)、乳铁蛋白 (LF)特异性酶联免疫吸附 (ELISA ANCA)。 2 5 2例患者中 182例行肾活检。结果　正常对照组 15 0例无 1例ANCA阳性 ,病例组 2 5 2例中 12例血清ANCA阳性 ,其中C ANCA 1例 ,atypical ANCA 1例 ,P ANCA 10例 ,识别MPO、LF及其他未测抗原 ,无 1例识别PR3;各肾小球疾病中的ANCA的阳性率 0 %～ 17% ,继发性肾小球疾病以狼疮性肾炎阳性率最高 (17% ) ;病理分布于中重度系膜增生性IgA肾病、局灶坏死性紫癜性肾炎、弥漫增殖型狼疮性肾炎等。结论　ANCA在各肾小球疾病中的发生率约 5 % ,不同疾病中的发生率不同 ,继发性肾小球疾病中以狼疮性肾炎阳性率最高 ;间接免疫荧光模式以P ANCA、atypical ANCA多见 ,而C ANCA少见 ;靶抗原以MPO、LF多见 ,而PR3少见 ;ANCA阳性对狼疮性肾炎、紫癜性肾炎、乙肝病毒相关性肾炎的临床鉴别诊断具有重要参考价值 。Objective To observe positive rate anti neutrophil cytoplastic antibody(ANCA),its indirect immunofluoresence(IIF) modes and target antigens distribution in many kinds of primary and secondary glomerulo diseases,in the same time,explore its clinic importance.Methods The normal controls(n=150) came from the healthy blood donors.The cases (n=252) were all kinds of glomerular disease patients,among them,182 did renal biopsy.All subjects serum was assayed of ANCA with the method of IIF, the positive (>1∶20 titer) then was assayed proteinase 3 of(PR3),medullar peroxidase(MPO),lactoferritin(LF) ELISA extensively.The statistic analysis χ 2 test was used.Results The controls′ positive rate was obviously lower than the cases (0% vs 4.8 %,P< 0.05 ).There were totally 12 positive in the cases,expectively C ANCA,atypical ANCA and P ANCA (1,1,10),and the target antigens are MPO,LF and others,PR3 was not visual.ANCA's positive rate varied with the disease type from 0% to 4.5 %.It was more often seen in secondary glomerular diseases than in the primary,especially in the lupus nephritis(LN) (17%).In the view of pathology,it was usually seen in IgA nephropathy,Henoch Sch ¨o nlein purpura nephritis(HSPN) and Ⅵ LN.Conclusion ANCA's positive rate is approximately 5% in all kinds of glomerular diseases,and varible with the disease types.It is the most highest in the LN.P ANCA,atypical ANCA are often seen,but rarely C ANCA,the antigen specificity are often MPO,LF and others?but rarely PR3.Using ANCA,LN can be distinguished from HSPN,HBV GN and others,moreover,proper treatment and predict in on prognosis of associated diseases can be available.

关 键 词：抗中性粒细胞胞浆抗体 肾小球疾病 检测 ANCA 

分 类 号：R692.6[医药卫生—泌尿科学]