抗中性粒细胞胞质抗体检测在风湿病诊断中的临床价值探讨

目的探讨抗中性粒细胞胞质抗体（ANCA）检测对风湿病患者诊断的临床意义。方法将965例风湿病患者作为风湿病组,其中,SLE 256例,MCTD 124例,RA 336例,干燥综合征（SS）166例,系统性硬化症（SSc）45例,皮肌炎38例。将400例健康体检者作为对照组。采用间接免疫荧光法（IIF）检测胞质型ANCA（c-ANCA）、核周型ANCA（p-ANCA）。ANCA阳性者采用酶联免疫吸附测定（ELISA）检测其抗髓过氧化物酶（MPO）抗体。结果风湿病组、对照组受检者血清ANCA的阳性率的差异有统计学意义（P〈0.01）,两组受检者ANCA阳性的血清中,p-ANCA与c-ANCA的阳性率的差异有统计学意义（P〈0.01）。伴SLE的患者血清p-ANCA的阳性率显著高于伴MCTD、RA、SS、SSc、皮肌炎患者及对照组受检者（P〈0.05）;伴MCTD的患者血清p-ANCA的阳性率显著高于伴RA、SS、SSc、皮肌炎者及对照组受检者（P〈0.05）。165例p-ANCA阳性的风湿病组患者抗MPO抗体的阳性率为58.4%,显著高于对照组受检者（3%）（P〈0.01）;ANCA阳性的风湿病组患者伴肾功能损害的阳性率为55.4%,显著高于ANCA阴性的风湿病组患者（21.8%）及对照组受检者（6.25%）（P〈0.01）。结论血清ANCA检测对预防风湿病患者肾毒性损害有重要意义。

A study on clinical values of antineutrophil cytoplasmic antibody detection in diagnosis of rheumatic diseases

Objective To investigate the clinical values of antineutrophil cytoplasmic antibody （ANCA） detection in the diagnosis of rheumatic diseases .Methods 965 patients with rheumatic diseases were taken as rheumatic group ,including 256 cases of SLE , 124 of mixed connective tissue disease（MCTD） ,336 of rheumatoid arthritis（RA） ,166 of Sjogren′s Syndrome（SS） ,45 of systemic sclerosis（SSc） and 38 of dermatomyositis .400 healthy people were served as the control group .Indirect immunofluorescence （IIF） was employed to detect the cytoplasmic ANCA （c-ANCA ） ,perinuclear ANCA （p-ANCA ） .Enzyme-linked immunosorbent assay （ELISA） was utilized to assay the anti-myeloperoxidase（MPO） antibody among patients with positive ANCA .Results Difference of positive rates of serum ANCA of subjects in rheumatic group and control group showed statistical significance （P〈0 .01） ,and the differences of positive rates of serum p-ANCA and c-ANCA of subjects with positive ANCA between the two group were also sta-tistically significant（P〈0 .01） .The positive rate of serum p-ANCA of patients with SLE was markedly higher than those with MCTD ,RA ,SS ,SSc ,dermatomyositis and healthy people in control group （P〈 0 .05） ,while that of patients with MCTD was obviously higher than those with RA ,SS ,SSc ,dermatomyositis and healthy people in control group （P〈0 .05） .The positive rate of anti-MPO antibody of 165 patients with positive ANCA in rheumatic group was 58 .4% ,which was significantly higher than that in control group（3% ）（P〈0 .01） .The positive rate of patients with positive ANCA and impaired renal function in rheumatic group was 55 .4% ,which was obviously higher than those of patients with negative ANCA in rheumatic group （21 .8% ） and control group （6 .25% ）（P〈0 .01） .Conclusion Serum ANCA detection is of important significance for prevention of nephrotoxic damage in pa-tients with rheumatic diseases .