Positive antineutrophil cytoplasmic antibody serology in patients with lupus nephritis is associated with distinct histopathologic features on renal biopsy.
Positive antineutrophil cytoplasmic antibody serology in patients with lupus nephritis is associated with distinct histopathologic features on renal biopsy.
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DOI：
10.1016/j.kint.2017.04.029
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发表时间：
2017-11
影响因子：
19.6
通讯作者：
Lightstone L
中科院分区：
文献类型：
--
作者：
Turner-Stokes T;Wilson HR;Morreale M;Nunes A;Cairns T;Cook HT;Pusey CD;Tarzi RM;Lightstone L
与IV-G型狼疮性肾炎相比，IV-S型狼疮性肾炎通常伴有更多的坏死和更少的内皮下免疫沉积，提示在抗神经细胞胞质抗体（ANCA）相关血管炎中发现的坏死性肾小球炎症。狼疮性肾炎患者中有很大一部分存在ANCA。在这里，我们确定ANCA是否与狼疮性肾炎不同的临床和组织病理学特征相关。将32例ANCA阳性活检与222例狼疮性肾炎患者ANCA阴性活检进行比较。大多数（82%）ANCA阳性患者有抗髓过氧化物酶抗体。在ANCA阳性组中，IV-S型狼疮性肾炎和肾小球坏死明显更常见（分别为36%和16%以及35%和15%），孤立性V型狼疮性肾炎明显不常见（10%和29%）。ANCA阳性患者活检时dsDNA滴度显著高于对照组（335u/ml vs.52u/ml），血清C4浓度显著低于对照组（0.125g/L vs.0.15g/L），血清肌酐显著高于对照组（130 μ mol/L vs.84 μ mol/L）。因此，ANCA似乎影响狼疮肾炎的组织学模式，并与基线肾功能较差和狼疮血清学更活跃相关。当使用倾向评分匹配疾病严重程度和治疗时，两组之间的结局无显著差异。因此，需要进一步的研究来检查狼疮肾炎患者中的ANCA是否具有致病作用，以及它们是否与更差的肾脏结局相关，或者仅仅是更严重疾病的标志物。
Class IV-S lupus nephritis is often associated with more necrosis and fewer subendothelial immune deposits compared to class IV-G lupus nephritis, suggestive of necrotising glomerular inflammation found in antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis. ANCAs are present in a significant proportion of patients with lupus nephritis. Here we determine whether ANCAs are associated with distinct clinical and histopathologic features of lupus nephritis. Thirty-two ANCA-positive biopsies were compared to 222 ANCA-negative biopsies from patients with lupus nephritis. The majority (82%) of ANCA-positive patients had antimyeloperoxidase antibodies. Class IV-S lupus nephritis and glomerular necrosis were significantly more common (36% vs. 16% and 35% vs. 15%, respectively) and isolated Class V lupus nephritis significantly less common (10% vs. 29%) in the ANCA-positive group. ANCA-positive patients had significantly higher dsDNA titers (335u/ml vs. 52u/ml), significantly lower serum C4 concentrations (0.125g/L vs. 0.15g/L) and significantly higher serum creatinine (130μmol/L vs. 84μmol/L) at the time of biopsy. Hence ANCAs appear to influence the histological pattern of lupus nephritis and are associated with worse baseline renal function and more active lupus serology. There was no significant difference in outcome between groups when matched for severity of disease and treatment using propensity scoring. Thus, further studies are needed to examine whether ANCAs in patients with lupus nephritis have a pathogenic role and whether they are associated with worse renal outcomes or are simply a marker of more severe disease.
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影响因子：
6.1
作者：
Schwartz, Melvin M.;Korbet, Stephen M.;Lewis, Edmund J.
通讯作者：
Lewis, Edmund J.
影响因子：
13.2
作者：
Charney, DA;Nassar, G;Nadasdy, T
通讯作者：
Nadasdy, T
影响因子：
13.6
作者：
Haring, Catharina M.;Rietveld, Anke;Berden, Jo H. M.
通讯作者：
Berden, Jo H. M.
影响因子：
13.2
作者：
Mittal, B;Hurwitz, S;Singh, AK
通讯作者：
Singh, AK
影响因子：
19.6
作者：
Hill, GS;Delahousse, M;Bariéty, J
通讯作者：
Bariéty, J