Analysis Of Clinical And Pathological Characterestics In Lupus Patients With Positive Anti-neutrophil Cytoplasmic Antibody

ObjectiveThere are lots of autoantibodies against nuclear antigens in systemetic lupuserythematosus (SLE) patients. Recently, many autoantibodies to cytoplasm and cellmembrane components have been found in SLE patients. Anti-neutrophil cytoplasmicantibodies (ANCA) now have become the specific serological markers for primarysystemic vasculitis. ANCA are also detectable in sera from SLE patients, espectially fromwhom with menifestations of secondary vasculitis. The possible role of ANCA in thepathogenesis and the clinical pathological changes in SLE have caused extensive attention.The purpose of this study, by comparing the clinical and renal pathological differencesamong SLE patients with ANCA-positive or ANCA-negative, is to improve ourunderstanding of clinical and pathological characteristics of SLE patients with positiveANCA, so as to provide reference for clinical diagnosis and treatment.Method196cases of SLE patients, who meet the1997modified classification criteria, wereenrolled in the study. These patients have detections of ANCA and other lupus relatedregular examinations, including antinuclear antibody spectrum, liver and kidney function,immunoglobulin, complement C3and C4, blood sedimentation, routine urine and bloodtests,and chest X-ray, electrocardiogram, ultrasonic testing of pericardium, chest,abdominal cavity. Lung spiral CT examination was performed in patients with suspectedpulmonary lesions. D dimer and blood gas analysis were detected when necessary. HeadCT or MR examination was performed in patients with nerve mental symptoms, andcerebrospinal fluid inspection detected when necessary. According to the results of ANCAdetection, patients were divided into positive group and negative group.89out of the196cases of patients underwent renal pathology biopsy. The AI and CI scores of the renalpathology were caculated. The study compared two groups of clinical manifestation,laboratory examination, pathological differences. Analyses were performed withSPSS17.0.Two-tailed P values<0.05were considered statistically significant.Results21cases of lupus patients showed p-ANCA positive, and the positive rate was10.71%. The incidence of oral ulcer, serositis, lupus lung and high blood pressure weremore common in ANCA positive group. The laboratory data, including hematuria,leukocyturia, renal failure and leukopenia, thrombocytopenia and hypocomplementemiashowed a significantly differert result. SLEDAI scores suggests that disease is more activein the positive group than that in negative group. There was a significant higherpercentage of type IV lupus nephritis and crescent, and the AI scores were more higher inpossive group. In short-term observation after treatment, The ANCA positive group isrelatively slow on controling proteinuria and improving renal function, comparing tonegative group. Methylprednisolone impact treatment can quickly control the condition. ConclusionANCA may be an active participant in clinical multisystem organ damages in SLEpatients. ANCA positive may be associated with the level of lupus activity and diseaseseverity. The renal pathologies of ANCA positive lupus patients were maily type Ⅳ lupusnephritis, and the AI scores were relatively higher. Also, there were more crescent in therenal pathologies. These findings may provide a reference for further treatment. Theappropriate intensive immunosuppressive therapy are helpful to control the disease,especially for patients with positive ANCA.