抗甲状腺药物引起抗中性粒细胞胞质抗体相关血管炎的临床分析  

Antineutrophil cytoplasmic antibody associated vasculitis induced by antithyroid agents

作　　者：郭晓蕙[1] 赵明辉[2] 高莹[1] 王淑凤[1] 高妍[1] 

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

出　　处：《中华医学杂志》2003年第11期932-935,共4页National Medical Journal of China

摘　　要：目的　探讨抗中性粒细胞胞质抗体 (ANCA)在原发性甲状腺功能亢进症 (甲亢 )不同阶段和不同药物治疗时的意义以及ANCA靶抗原与血管炎临床表现的关系。方法　将在北京大学第一医院就诊的 2 1 6例原发甲亢患者分为初发未治疗组 (n =34) ,丙基硫氧嘧啶 (PTU )组 (n =62 ) ,他巴唑 (MMI)组 (n =77)和混合用药组 (n =43)。应用间接免疫荧光法 (IIF)检测患者血清 ,对ANCA和抗核抗体 (ANA)IIF检测为阳性的患者 ,进一步应用ELISA法检测 7种ANCA靶抗原 ,即髓过氧化物酶 (MPO)、蛋白酶 3(PR3)、乳铁蛋白 (LF)、人弹力蛋白酶 (HLE)、天青杀素 (AZU )、组织蛋白酶G(CG)和杀菌 /通透性增高蛋白 (BPI)。结果　未治疗组IIF阳性者占 5 9% (2 / 34) ;PTU组IIF阳性者占 2 2 6 % (1 4 / 62 ) ,均为IIF ANCA阳性 ;MMI组中占 6 5 % (5/ 77) ,均为IIF ANA阳性 ;混合组中占 2 7 9% (1 2 / 4 3) ,8例IIF ANA阳性 ,3例IIF ANCA阳性。PTU组IIF ANCA的阳性率高于未治疗组 (P <0 0 1 7) ;PTU组IIF及IIF ANCA的阳性率均高于MMI组 ,差异有显著意义 (P <0 0 1 7)。服药的 1 82例患者中 ,6/ 31例IIF阳性的患者 (1 9 4% )出现了血管炎相关症状。 6例中 4例 (66 7% )识别MPO ,2例 (33 3 % )识别PR3 ,4例识别LF ,3例识别 (HLE) 。Objective To investigate the significance of antineutropil cytoplasmic antibody (ANCA) in hyperthyroidism at different stages and treated with different drugs and to investigate the relationship between the ANCA specific target antigens and the clinical manifestations of vasculitis Methods Two hundred and sixteen patients with hyperthyroidism were divided into four groups: untreated ( n =34), treated with propylthiouracil (PTU) ( n =62), treated with methimazole (MMI) ( n =77), and treated with both PTU and MMI ( n =43) Sera were collected from the 216 patients Indirect immunofluorescence (IIF) test was used to detect the ANCA and antinuclear antibody (ANA) Antigen specific ELISA was used to detect the existence of 7 specific target antigens of ANCA: myeloperoxidase (MPO), proteinase 3 (PR3), lactoferrin (LF), human leukocyte elastase (HLE), azurocidin (AZU), cathepsinG (CG), and bactericidal/permeability increasing protein (BPI) in the sera positive in ANCA and ANA determined by IIF Results The IIF positive rate was 5 9% (2/34) in the untreated group; 22 6% (14/62) in the patients treated with PTU, all IIF ANCA positive; 6 5% (5/77) in the patients treated with MMI, all IIF ANA positive; and 27 9% (12/43) in the patients treated with both PTU and MMI, 8 IIF ANA positive and 3 IIF ANCA positive The IIF ANCA positive rate in the patients receiving PTU was significantly higher than that in the untreated patients ( P <0 017) The IIF ANA and IIF ANCA positive rates of the patients treated with PTU were both significantly higher than those of the patients treated with MMI ( P <0 017) Six of the IIF positive 31 patients administered with drugs (19 4%) had signs and symptoms associated with vasculitis Of the six patients, 4 were MPO antibody positive (66 7%), 2 were PR3 antibody positive (33 3%), 4 were LF antibody positive, 3 were HLE antibody positive, 3 were AZU antibody positive, and 2 were CG antibody positive None was anti BPI antibody positive Two of the si

关 键 词：抗甲状腺药物 抗中性粒细胞胞质抗体 血管炎 间接免疫荧光法 ELISA法 靶抗原 诊断 

分 类 号：R595.3[医药卫生—内科学]