■探讨血清抗中性粒细胞胞浆抗体(ANCA)与临床病理特征的相关性,诱导治疗反应,狼疮性肾炎(LN)患者的预后。
■在这项回顾性研究中,2010年10月至2020年9月活检证实的LN患者采用间接免疫荧光和ELISA检测血清ANCA,分为ANCA阳性组和ANCA阴性组.分析比较两组患者的临床病理资料。
■115例患者中有35例(30.43%)的ANCA血清阳性。ANCA阳性患者的系统性红斑狼疮活动指数和活动指数评分明显增高,更高的24小时尿蛋白,和低补体三个水平(p分别为0.001、0.028、0.023、0.009)。口腔溃疡的发病率,血小板减少症,和白细胞增多症,ANCA阳性组抗dsDNA抗体和组蛋白抗体的阳性率明显高于ANCA阳性组(p分别为0.006、0.019、0.012、0.001、0.019)。在ANCA阳性组中,IV类LN和纤维蛋白样坏死/核破裂明显更常见(p=0.027,0.002)。接受环磷酰胺和霉酚酸酯作为诱导疗法的ANCA阳性患者的总缓解率没有显着差异(83.33%vs.66.67%,P>0.05),而接受环磷酰胺诱导治疗的患者总缓解率高于接受其他免疫抑制剂的患者(83.33%vs.20%,p=0.028)。
■在肾活检中具有ANCA血清阳性的LN患者具有明显更高的疾病活动性,其病理表现以增殖性LN为主。这些患者需要使用环磷酰胺或霉酚酸酯进行更积极的免疫抑制治疗,以提高缓解率。
UNASSIGNED: To investigate the correlations between serum antineutrophil cytoplasmic antibody (ANCA) and clinicopathological features, induction treatment response, and prognosis of lupus nephritis (LN) patients.
UNASSIGNED: In this retrospective study, biopsy-proven LN patients from October 2010 to September 2020 were tested for serum ANCA by indirect immunofluorescence and ELISA and were divided into ANCA-positive group and ANCA-negative group. The clinicopathological data of the two groups were analyzed and compared.
UNASSIGNED: Thirty-five of 115 patients (30.43%) were seropositive for ANCA. ANCA-positive patients had significantly higher systemic lupus erythematosus activity index and activity index scores, higher 24-h urinary protein, and lower complement three levels (p = 0.001, 0.028, 0.023, 0.009, respectively). The incidences of oral ulcers, thrombocytopenia, and leukocyturia, and the positive rates of anti-dsDNA antibody and anti-histone antibody were significantly higher in ANCA-positive group (p = 0.006, 0.019, 0.012, 0.001, 0.019, respectively). Class IV LN and fibrinoid necrosis/karyorrhexis were significantly more common in the ANCA-positive group (p = 0.027, 0.002). There was no significant difference in the total
remission rate of ANCA-positive patients receiving cyclophosphamide and mycophenolate mofetil as induction therapies (83.33% vs. 66.67%, p > 0.05), while patients receiving cyclophosphamide as induction therapy had a higher total
remission rate than those receiving other immunosuppressants (83.33% vs. 20%, p = 0.028).
UNASSIGNED: LN patients with ANCA seropositivity at renal biopsy have a significantly higher disease activity, and their pathological manifestations are predominantly proliferative LN. These patients require a more active immunosuppressive therapy with cyclophosphamide or mycophenolate mofetil to improve their
remission rate.