摘要
目的：抗中性粒细胞胞浆抗体（ antineutrophil cytoplasmic antibodies， ANCA）相关性血管炎（ ANCA-associated vasculitis， AAV）是一组累及全身小血管的致死性疾病，髓过氧化物酶（ myeloperoxidase， MPO）为ANCA识别的主要抗原之一。文中通过检测活动期MPO-AAV患者外周血中MPO、活化补体C5a片段及铜蓝蛋白（ceruloplasmin， Cp）水平的变化，进一步探索上述血清标志物的临床意义。方法选取活动期MPO-AAV患者132例为病例组，健康志愿者30例为对照组。通过间接免疫荧光法及ELISA法分别检测病例组的p-ANCA及MPO-ANCA；ELISA法检测并比较2组的MPO、C5a及Cp水平；根据伯明翰血管炎活动性评分（birmingham vasculitis activity score， BVAS）量表，记录患者的BVAS，分析病例组中MPO、C5a、Cp及MPO-ANCA间的相关性，并探讨上述各指标与BVAS的关系。结果外周血MPO、C5a、Cp水平在病例组中分别为400．7（333．5～506．1）IU／L、336．7（277．6～403．5）ng／mL、481．1（387．9～535．9）ng／mL，在对照组中分别为286．9（225．5～329．1）IU／L、236．8（204．2～304．1）ng／mL、326．9（177．1～405．5）ng／mL，病例组上述各指标均明显高于对照组，差异均具有统计学意义（P＜0．05）。病例组MPO与Cp呈显著正相关（ r＝0．663，P＜0．001）；C5a与MPO、Cp的相关系数分别为0．792、0．637，均呈显著正相关（ P＜0．001）；MPO-ANCA与总BVAS、肾BVAS及肺BVAS的相关系数分别为0．247、0．339、0．191，均呈显著正相关（ P＜0．05）；p-ANCA与肾BVAS呈正相关（ r＝0．208，P＜0．05）；C5a与肾BVAS呈负相关（ r＝－0．207，P＜0．05）。结论活动期MPO-AAV患者周围血中MPO、Cp及C5a水平均明显升高，相互之间及与ANCA之间复杂的相互作用可能共同影响MPO-AVV的临床损害，其中，MPO-ANCA存在较明显影响，C5a对肾损害影响较明显。
Objective Antineutrophil cytoplasmic antibody （ANCA） associated vasculitis（AAV）is a systemic necrotizing small-vessel vasculitis, and myeloperoxidase（MPO） is one of the main antigens that ANCA can recognize.This study was to investigate the clinical significance of MPO, activated complement C5a fragment and ceruloplasmin （ Cp） in the peripheral blood of patients with MPO-ANCA associated vasculitis （ MPO-AAV） in active phase by observing their changes. Methods 132 MPO-AAV patients at active stage were selected as the patient group, while the control group was made up of 30 healthy controls.Peri-nuclear ANCA （p-ANCA） and MPO-ANCA in the patient group were detected by IIF and ELISA, respectively.The levels of MPO, Cp and C5a in both groups were tested by ELISA.The Birmingham vasculitis activity score （BVAS） of every patient was calculated.In the patient group, the relationship among MPO, Cp, C5a and MPO-ANCA were analysed, and the association between BVAS and each of them was also explored. Results The levels of MPO, CP, C5a in the patient group were significantly higher than those in the health control group [MPO：400.7（333.5---506.1） vs 286.9（225.5--329.1）IU/L, P30.001;C5a：336.7 （277.6--403.5） vs 236.8 （204.2--304.1） ng/mL, P30.001;Cp：481.1 （387.9--535.9） vs 326.9 （177.10---405.5） ng/mL,P30.001].The associations between MPO and＆nbsp;Cp, C5a and MPO, C5a and Cp in the patient group were statistically significant （ r=0.663, P30.001;r=0.792, P30.001;r=0.637, P30.001, respectively）.No significant correlation was found in MPO-ANCA and any of these indexes.MPO-ANCA had a positive association with the total BVAS, the kidney BVAS, and the lung BVAS （ r=0.247, P=0.004;r=0.339,P30.001 and r=0.191, P=0.028, respec-tively） .p-ANCA had a positive correlation with the kidney BVAS （ r=0.208, P=0.017） while C5a had a negative correlation with the kidney BVAS （ r=-0.207, P=0.018） . Conclusion The levels of MPO, Cp and C5a increased significantly in the peripheral blood of MPO-AAV patients in active phase.The complex interactions among MPO, Cp, C5a and ANCA might influence the clinical damage in MPO-AAV.Notablely, the influence from MPO-ANCA might be most obvious while C5a might affect renal damage more markedly.
出处
《医学研究生学报》
CAS
北大核心
2015年第4期406-410,共5页
Journal of Medical Postgraduates
基金
中华医学会临床医学科研专项资金(08010290107)
关键词
抗中性粒细胞胞质抗体
髓过氧化物酶
铜蓝蛋白
相关性血管炎
C5a
Antineutrophil cytoplasmic antibodies
Myeloperoxidase
C5a
Ceruloplasmin
ANCA associated vasculitis
作者简介
通讯作者：帅宗文，E-mail：shuaizongwen@medmail．com．cn
