非典型抗中性粒细胞细胞质抗体在自身免疫性疾病中的检测效果

摘要

目的 研究非典型抗中性粒细胞细胞质抗体(ANCA)在自身免疫性疾病中的检测效果.方法 选取2011年12月至2016年9月该院确诊的自身免疫性疾病或炎性疾病患者1 963例,疾病种类包括系统性红斑狼疮(SLE)、溃疡性结肠炎(UC)、自身免疫性肝炎(AIH)、类风湿关节炎(RA)、干燥综合征(SS)、强直性脊椎炎(AS)和皮肌炎(DM);另取同期参加体检的健康志愿者50例作为健康对照组.采用间接免疫荧光法(IIF)、蛋白印迹(WB)和酶联免疫吸附试验(ELISA)检测全部研究对象血清中典型与非典型ANCA的情况.结果 SLE患者ANCA阳性率为24.65％,SS患者ANCA阳性率为10.88％,RA患者ANCA阳性率为9.79％,UC患者ANCA阳性率为20.83％.DM、AS及AIH患者样本量均较少.50例健康对照组ANCA检测结果均为阴性.ANCA阳性,而抗-髓过氧化物酶(MPO)和抗-蛋白酶3(PR3)阴性患者121例中,24例为抗-乳铁蛋白(LF)阳性,3例为抗-杀菌/渗透增强蛋白(BPI)阳性,1例为抗-弹性蛋白酶阳性.典型ANCA与非典型ANCA组患者在性别比、年龄、疾病种类和病程方面差异均无统计学意义(P＞0.05).结论 自身免疫性疾病或炎性疾病患者血清ANCA阳性率较高,继续采用ELISA进行针对性筛查可发现绝大部分靶抗原为抗-MPO和抗-PR3,少数患者存在抗-LF和抗-BPI等非典型ANCA.%Objective To investigate the effects of atypical anti neutrophil cytoplasmic antibody (ANCA) in the detection of autoimmune diseases.Methods A total of 1 963 patients with autoimmune or inflammatory diseases diagnosed in the hospital from December 2011 to September 2016 were selected.The disease types ineluded systemic lupus erythematosus (SLE),ulcerative colitis (UC),autoimmune hepatitis (AI),rheumatoid arthritis (RA),Sjogren's syndrome (SS),ankylosing spondylitis (AS) and dermatomyositis (DM).Another 50 healthy volunteers participated in the physical examination as the healthy control group were selected,indirect immunofluorescence (IIF),western blot (WB) and enzyme-linked immunosorbent assay (ELISA) were used to detect the presence of typical and atypical ANCA in serum of all subjects.Results The positive rate of ANCA was 24.65％ in SLE patients,10.88％ in SS patients,9.79％ in RA patients and 20.83％ in UC patients.Patients with DM,AS and AIH had fewer specimens.The results of ANCA in 50 healthy controls were negative.ANCA positive,and anti-myeloperoxidase (MPO) and anti-protease 3 (PR3) negative patients were 121 cases,24 cases were anti-lactoferrin (LF) positive,3 cases were anti-bacterial/osmotic enhanced protein (BPI) positive,and one was anti-elastase positive.There was no significant difference in sex ratio,age,type of disease and course of disease among patients with typical ANCA and aty.pical ANCA (P＞0.05).Conclusion Serum ANCA positive rate is higher in patients with autoimmune diseases or inflammatory diseases.The targeted screening with ELISA continue to find that most of the target antigens are anti-MPO and anti-PR3,and a few patients have atypical ANCA such as anti-LF and anti-BPI.