作者：RaoDA翻译：邓晓莉校正：张警丰金银姬发布者：武东
1
目的
明确免疫荧光阴性而MPO/PR3阳性的结果是否有临床意义。
2
方法
回顾性分析2年内所有免疫荧光阴性而MPO/PR3阳性患者的临床资料。
3
结果
所有例样本中例荧光阴性。荧光阴性的样本中来自38例患者的49例（2.5%）样本为MPO-ANCA或者PR3-ANCA阳性。只有1例免疫荧光阴性而MPO/PR3阳性患者随后被临床诊断为ANCA相关性小血管炎。11例免疫荧光阴性而MPO/PR3阳性的患者(29%)之前被诊断为ANCA相关性小血管炎而给予了相应的治疗，并且在治疗前免疫荧光和抗体检测结果都是阳性的。4例患者有皮肤血管炎证据但是与ANCA相关性小血管炎无关，其他的免疫荧光阴性而MPO/PR3阳性患者均有免疫异常表现，包括系统性红斑狼疮（5例）以及炎症性肠病（3例）。
4
结论
从这项来自现实生活的队列研究可看出，免疫荧光阴性而MPO/PR3阳性很少会被新诊断为系统性血管炎，更多的是见于其它非血管炎性炎症状态。结果提示，同时检测免疫荧光和MPO/PR3抗体对于避免新发ANCA相关性小血管炎的漏诊价值有限。
5
附原文
OBJECTIVE:Concurrenttestingforserumantineutrophilcytoplasmicantibodies(ANCA)byindirectimmunofluorescence(IF)andbyantiproteinase3(PR3)/antimyeloperoxidase(MPO)antibodyassaysmayidentifypatientswithPR3-ANCAorMPO-ANCAdespiteanegativeIF(IF-negativeMPO/PR3-positive);however,thesignificanceofthisresultisnotclear.WesoughttodeterminewhetherIF-negative,MPO/PR3-positiveresultsidentifiedanycasesofclinicallymeaningfulsystemicvasculitisatourinstitution.METHODS:WeconductedaretrospectivechartreviewofallIF-negative,MPO/PR3-positivepatientsidentifiedatourinstitutionovera2-yearperiod.RESULTS:Ofthesamplestestedover2years,wereIF-negative.AmongtheseIF-negativesamples,49samples(2.5%)derivedfrom38patientstestedpositiveforMPO-ANCAorPR3-ANCA.Only1IF-negative,MPO/PR3-positivepatientwassubsequentlydiagnosedwithANCA-associatedvasculitis(AAV).ElevenIF-negative,MPO/PR3-positivepatients(29%)hadbeenpreviouslydiagnosedandtreatedforAAV,allwithpositiveIFandantibodytestspriortotreatment.FourpatientshadevidenceofcutaneousvasculitisnotattributedtoAAV,whileseveraloftheremainingIF-negative,MPO/PR3-positivepatientshadotherimmunologicdisorders,includingsystemiclupuserythematosus(5patients)andinflammatoryboweldisease(3patients).CONCLUSION:Inthisreal-lifecohortassayedsimultaneouslybyIFandmultiplexedbeadassays,thedetectionofMPO-ANCAorPR3-ANCAwithoutapositiveIFrarelyledtoanewdiagnosisofsystemicvasculitis,andwasmorelikelytooccurinthecontextofanon-vasculiticinflammatorycondition.OurresultssuggestthatconcurrentIFandMPO/PR3testingmaybeoflimiteduseinpreventingamisseddiagnosisofnew-onsetAAV.
6
引自
RaoDA,WeiK,MerolaJF,OBrienWR,TakvorianSU,DellaripaPF,SchurPH.Myeloperoxidase-antineutrophilCytoplasmicAntibodies(MPO-ANCA)andProteinase3-ANCAwithoutImmunofluorescentANCAFoundbyRoutineClinicalTesting.JRheumatol.May;42(5):-52.
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