| Background: Systemic lupus erythematosus(SLE)and ANCA-associated vasculitis(AAV)are all autoimmune diseases,Reported that SLE and lupus nephritis(LN)patients with a certain positive rate of ANCA,often prompted SLE,LN activity,However,some studies have found that SLE atypical ANCA more,perhaps only represents a SLE in a self-antibody composition,not representative.So the current ANCA-positive in the SLE,LN pathogenesis of disease activity and severity of the impact were controversialed.Objective: To study the positive rate of ANCA in SLE patients and the effect of ANCA on activity and severity of SLE and LN.Methods: Selected SLE patients who admitted in Department of Nephrology and Rheumatology in the Affiliated Second Hospital of Dalian Medical University from January 2008 to December 2016 and the collected clinical data.The diagnostic criteria was according to the 2009 SLICC at the ACR meeting proposed SLE new diagnostic criteria.Inclusion criteria: 1)patients who were diagnosed with systemic lupus erythematosus(SLE);2)patients who were diagnosed with lupus nephritis(LN);3)patients who had undergone ANCA-related examinations.Exclusion criteria: 1)SLE patients,but no ANCA-related test;2)patients with anti-GBM antibodiespositive;3)patients with hydralazine,mepyridazine,propylthiouracil drugs(such drugs can cause ANCApositive);4)exclude patients who contacted with the silicon environment,glass factory and textile mill patients.5)patients with type I autoimmune liver disease(AIH),primary sclerosing cholangitis,primary biliary cirrhosis;6)patients who repeated hospitalization,incomplete data.Collected for all patients ' age,sex,PR3 antibody,anti-MP0 antibody,c ANCA,p ANCA,antinuclear antibody(ANA),anti-double-stranded DNA(ds DNA)antibody,Anti-Sm antibody,anti-r RNP antibody,complement C3,complement C4,Ig G,Ig M,anti-MPO antibody,c ANCA,p ANCA,antinuclear antibody(ANA),anti-ds DNA antibody,(WBC),hemoglobin,platelet count(PLT),serum creatinine(Scr),high sensitive C-reactive protein(CRP),24-hour urinary protein,urine routine and SLEDAI score.SPSS22.0 statistical software for statistical analysis and processing of data,p <0.05 that the difference was statistically significant.Results: In this study,a total of 218 subjects,of which p ANCA-positive patients were122/218(55.96%),anti-MPO positive 19/218(8.71%).The complete information cases were 157(68 cases of lupus nephritis),including 138 cases of female and 19 cases of male,the ratio of male to female was 1: 7.26,the average age was 42.55 ± 17.23 years old,the positive rate of p ANCA was 88/157(56.05%),the positive of anti-MPO was15/157(24.8%),the negative of ANCA was 69/157(43.94%),ANCA positive lupus nephritis(LN)was 39/68(57.35%),ANCA-negative lupus nephritis(LN)was 29/68(42.65%).1.SLE patients with p ANCA positive : The statistical analysis showed Ig G,anti ds DNA antibody titer,positive rate of ANA(1: 320)and ANA(1: 3200),anti-SM antibody(+),anti-r RNP antibody(+),SLEDAI score were higher in p ANCA positive SLE group than that in ANCA negative SLE group(P <0.05).The levels of complement C3,C4,white blood cell(WBC)were lower in p ANCA positive SLE group than those of ANCA negative SLE(p <0.05).Ig A,Ig M,Ig E,ANA(1: 100+),platelet(PLT),serum creatinine(SCr),24 hours urine protein,glomerular filtration rate(e GFR),Reactive protein(CRP),erythrocyte sedimentation rate,the ratio of male to female and the proportion of lupus kidney were not statistically significant between the two groups(p> 0.05)2.SLE patients with anti-MPO antibody positive and p ANCA positive: The results showed that the levels of complement C3,WBC in anti-MPO-positive and p ANCA positive SLE group were lower than those in anti-MPO-negative SLE group(p<0.05),the ANA(1: 1000+),ANA(1: 3200+),Ig G,r RNP antibody(+),CRP were higher in the anti-MPO positive SLE group than that in anti-MPO negative SLE group(p <0.05).Ig A,Ig M,Ig E,anti-ds DNA,anti-Sm antibody,PLT,hemoglobin,serum creatinine,e GFR,24 hours urine protein,erythrocyte sedimentation rate was no significant difference between the two groups(P> 0.05)3.LN patients with p ANCA positive: The statistical analysis showed IgG,anti-ds DNA antibody titer,ANA(1: 320+),ANA(1: 1000+),ANA(1: 3200+)and SLEDAI score were higher in p ANCA positive LN group than those of ANCA negative LN group(p <0.05),The levels of complement C3,C4,WBC,platelet p ANCA positive LN group were lower than those of ANCA negative LN group(p <0.05).Ig M,Ig A,Ig E,anti-Sm antibody(+)positive,hemoglobin,serum SCr,24 hours urine protein,e GFR,CRP,erythrocyte sedimentation rate,the ratio of men and women in this study was no significant difference between the two groups(P> 0.05).4.LN patients with anti-MPO antibody positive and p ANCA positive: Anti-MPO positive and p ANCA positive LN group in the Ig G,ANA(1: 1000+),ANA(1: 3200+),anti-Sm antibody(+),CRP,erythrocyte sedimentation rate was higher than anti-MPO negative LN group(p <0.05),The levels of C3 and C4 in MPO positive LN group were lower than those in anti-MPO negative LN group(p <0.05).Ig A,Ig M,Ig E,anti ds DNA antibody,anti-r RNP antibody(+),WBC,PLT,hemoglobin,serum creatinine,e GFR,24 hours urine protein,SLEDAI score,male and female ratio were not statistically significant differences between the two groups(P> 0.05).5.Among the 68 patients with lupus nephropathy,8 of them had renal biopsy,among which 5 were p ANCA positive(62.5%),ANCA negative(37.5%).p ANCA positive have1 case showed lupus nephrotic pathology stage II,1 case showed stage I V / V,3case stage IV;ANCA negative have 1 case of lupus nephropathy pathology stage V,2 cases of stage IV.Conclusions:1)In this study,122/218(55.96%)patients were positive for p ANCA and 19/218(8.71%)patients were positive for anti-MPO and p ANCA,no c ANCA positive or anti-PR3 antibody positive was found in patients with systemic lupus erythematosus;2)ANCA positive in this study prompted the activity of SLE;3)In this study,the positive rate of ANCA in LN was higher than that in non-LN but have no relationship of the severity in kidney damage. |
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