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23-9-第九节 抗中性粒细胞胞浆抗体
抗中性粒细胞胞浆抗体(antineutrophil cytoplasmic antibody, ANCA)是一种以中性粒细胞和单核细胞胞浆成分为靶抗原的自身抗体。1982年,Davies等在8例节段性坏死性肾小球肾炎患者血清中首次发现了ANCA。现已发现,ANCA自身抗体谱存在十余种特异性抗体,ANCA对系统性血管炎、炎性肠病和自身免疫性肝病等疾病的诊断与鉴别诊断具有重要意义。ANCA已成为自身免疫病重要的临床常规检测项目(详见第22章)。ANCA是自身免疫性肝病标准诊断谱的最新成员,主要见于自身免疫性肝病中的AIH-Ⅰ型及 PSC患者中,而PBC患者则少见。自身免疫性肝病中出现的ANCA,其免疫荧光染色型为核周型 ANCA(perinuclear ANCA, pANCA)或非典型性AN-CA(atypical ANCA, aANCA或xANCA)。其特异性靶抗原尚未完全清楚,可能是肌动蛋白(actin)或位于核板层(lamina)的某些粒细胞特异性抗原成分,而不同于原发性系统性血管炎患者中ANCA所常对应的特异性靶抗原,如蛋白酶3 ( proteinase 3, PR3)和髓过氧化物酶(myeloperoxidase, MPO)等。0 b7 Y2 U2 g: B- Z8 _7 }+ `
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一、检测方法
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& K( L; `/ a! \" [ 因尚未完全清楚自身免疫性肝病中出现的ANCA所对应的特异性靶抗原,以肝胆损伤等症状为主的自身免疫性肝病患者,常规检测ANCA可只选用间接免疫荧光法,检测结果ANCA阳性免疫荧光染色型多为pANCA或aANCA。
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% f2 ~$ k F3 w7 Q$ ^% r. S- P4 T6 M2 g8 t 二、临床意义 ! i# Z ?$ u ]% G$ Y* p; N: V6 y
( p1 k) b5 A7 _. o pANCA主要见于自身免疫性肝病中的AIH-Ⅰ型及 PSC患者中,阳性率分别为 65%~92%,29%~88%,而AIH- II型、PBC及其他非自身免疫性肝病患者中则少见。ANCA检测有助于自身免疫性肝病患者的诊断、分型及鉴别诊断,并可用于慢性隐源性肝病的分类。 0 Z( P& }7 f; W6 ~ V
' d8 K' O; s. i2 y9 l+ t4 dpANCA与AIH-Ⅰ型的疾病活动度(转氨酶和γ-球蛋白水平)相关,ANCA阳性患者的病情常较重。pANCA阳性的PSC患者,合并溃疡性结肠炎(ulcerative colitis, UC)的可能性较大,亦与胆管树受累广度相关,病情往往较重。
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