Renal histology in ANCA-associated vasculitis:: Differences between diagnostic and serologic subgroups
Renal histology in ANCA-associated vasculitis:: Differences between diagnostic and serologic subgroups
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DOI：
10.1046/j.1523-1755.2002.00089.x
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发表时间：
2002-01-01
影响因子：
19.6
通讯作者：
Hagen, EC
中科院分区：
文献类型：
--
作者：
Hauer, HA;Bajema, IM;Hagen, EC
背景显微镜下多血管炎（MPA）和韦格纳肉芽肿病（WG）之间的肾脏组织病理学差异，以及ANCA相关血管炎患者的抗中性粒细胞胞浆自身抗体（ANCA）检测结果之间的差异，可能会提供对发病机制差异的深入了解，并提高对血管炎进行更准确分类的机会。在本研究中的组织病理学的可能差异进行了研究。我们报告了173例显微镜下多血管炎或韦格纳肉芽肿性肾病患者的分析，共173例肾活检，在诊断时进行，分别由两名观察员，使用以前的标准化协议进行评分。在中心审查期间，对每个活检达成共识。正常肾小球在WG组较MPA组多见（P < 0.001）。肾小球硬化在MPA组较WG组更为明显（P = 0.003）。间质纤维化（P < 0.001）。肾小管萎缩（P < 0.001）。与WG相比，MPA中管型的出现频率更高且程度更严重（P = 0.005）。髓过氧化物酶（MPO）-ANCA患者的肾小球硬化比蛋白酶3（PR 3）-ANCA患者更广泛（P = 0.022）。间质纤维化（P = 0.008）、肾小管坏死（P = 0.030）、肾小管萎缩（P 0.013）。MPO-ANCA组中上皮内浸润（P = 0.006）的发生率和严重程度均高于PR 3-ANCA组。与MPA相关的肾小球肾炎在出现时比与WG相关的肾小球肾炎具有更多的慢性损伤特征，这种差异可能是由于与WG患者相比，NIPA患者的诊断延迟。活动性和慢性病变在MPO-ANCA阳性患者中比在PR 3-ANCA阳性患者中更丰富，这表明这些ANCA亚群中肾脏疾病的发病机制可能不同。我们的研究结果还表明，ANCA测试结果可能是有用的分类ANCA相关的血管炎。
Background. Differences in renal histopathology between microscopic polyangiitis (MPA) and Wegener's granulomatosis (WG), and between anti-neutrophil cytoplasm autoantibody (ANCA) test results in patients with ANCA-associatcd vasculitis may provide insight into the differences in pathogenesis and raise the opportunity of classifying the vasculitides more accurately. The possible differences in histopathology are investigated in this study.Methods. We report an analysis of 173 patients with renal disease in microscopic polyangiitis or Wegener's granulomatosis, A total of 173 renal biopsies, performed at diagnosis, were scored by two observers separately, using a previously standardized protocol. Consensus on each biopsy was achieved during a central review.Results. Normal glomeruli were more common in WG than in MPA (P < 0.001). Glomerulosclerosis was more prominent in MPA than in WG (P = 0.003). Interstitial fibrosis (P < 0.001). tubular atrophy (P < 0.001). and tubular casts (P = 0.005) were more frequently present and more severe in MPA than in WG. Presence of glomerulosclerosis was more extensive in patients with myeloperoxidase (MPO)-ANCA than with proteinase 3 (PR3)-ANCA (P = 0.022). Interstitial fibrosis (P = 0.008), tubular necrosis (P = 0.030), tubular atrophy (P 0.013). and intra-epithelial infiltrates (P = 0.006) were more frequently present and more severe in MPO-ANCA than in PR3-ANCA.Conclusions. Glomerulonephritis in relation to MPA has more characteristics of chronic injury at the time of presentation than glomerulonephritis in relation to WG, This difference may be due to a delayed establishment of diagnosis in patients with NIPA compared to patients with WG. Both active and chronic lesions are more abundantly present in MPO-ANCA-positive patients than in patients with PR3-ANCA-positivity which suggests that the pathogenesis of renal disease in these ANCA subsets could be different. Our results also suggest that ANCA test results may be useful in classifying ANCA-associated vasculitides.