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Analysis of Antineutrophil Cytoplasm Antibody from 118 730 Patients In CLINICAL RESEARCH e-ISSN 1643-3750 © Med Sci Monit, 2017; 23: 4312-4320 DOI: 10.12659/MSM.905880 Received: 2017.06.22 Accepted: 2017.08.13 Analysis of Antineutrophil Cytoplasm Antibody Published: 2017.09.07 from 118 730 Patients in Tertiary Hospitals in Jiangxi Province, China Authors’ Contribution: ABCDEFG 1 Liming Tan 1 Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang Study Design A ABCDEF 2 Anjun Jiao University, Nanchang, Jiangxi, P.R. China Data Collection B 2 School of Public Health, Nanchang University, Nanchang, Jiangxi, P.R. China Statistical Analysis C BCDEF 1 Juanjuan Chen 3 Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang Data Interpretation D BCDE 2 Xiaojing Feng University, Nanchang, Jiangxi, P.R. China Manuscript Preparation E BCEG 2 Liuyue Xu 4 Department of Clinical Laboratory, Jiangxi Provincial People’s Hospital, Nanchang, Literature Search F Jiangxi, P.R. China Funds Collection G BCDE 2 Siqi He 5 Department of Clinical Laboratory, Jiangxi Provincial Hospital of Traditional BEG 2 Fuyan Tan Chinese Medicine, Nanchang, Jiangxi, P.R. China B 1 Yongqing Jiang 6 Department of Clinical Laboratory, The Fourth Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China B 1 Heng Luo 7 Department of Clinical Laboratory, The Affiliated Hospital of Jiujiang University, B 1 Hua Li Jiujiang, Jiangxi, P.R. China B 1 Yang Wu 8 Department of Clinical Laboratory, Yichun People’s Hospital of Jiangxi Province, Yichun, Jiangxi, P.R. China B 1 Yongjian Tian 9 Department of Clinical Laboratory, The Affiliated Hospital of Gannan Medical B 1 Tingting Zeng University, Ganzhou, Jiangxi, P.R. China B 1 Jianlin Yu 10 Department of Clinical Laboratory, Ganzhou People’s Hospital of Jiangxi Province, Ganzhou, Jiangxi, P.R. China B 1 Liping Cao 11 Department of Clinical Laboratory, Pingxiang People’s Hospital of Jiangxi B 1 Jianfeng Zheng Province, Pingxiang, Jiangxi, P.R. China B 1 Hui Xu B 1 Ming Wei B 1 Wen Gan B 3 Weihua Peng B 4 Yanming Liu B 5 Jing Hou B 6 Jiangxia Xu B 7 LiHua Shuai B 8 Wenzhi Huang B 9 Junyun Huang B 10 Yan Lin B 11 Jianrong Liu Corresponding Author: Liming Tan, e-mail: [email protected] Source of support: Departmental sources Background: The discovery of antineutrophil cytoplasm antibody (ANCA) makes the early diagnosis of primary vasculitis pos- sible, and also has important guiding significance for the diagnosis and treatment of secondary vasculitis. This study aimed to investigate the clinical significance of ANCA. Material/Methods: ANCA was detected by indirect immunofluorescence assay (IIF), and anti-myeloperoxidase (MPO) antibody, and anti-proteinase 3 (PR3) antibody were detected by ELISA. The results were analyzed retrospectively. Results: Among 118 730 patients, a total of 5853 (4.93%) were positive for ANCA. In the positive cases, 3.98% were male and 6.33% were female, with significant differencesc ( 2=123.38, P<0.01). For ANCA, the department with the highest positive rate (15.06%) was the Department of Rheumatology, followed by 7.78% in the Department of Dermatology, 6.79% in the Department of Nephrology, and 5.72% in the Department of Traditional Chinese Medicine (TCM). Anti-PR3 and cANCA were highly specific in primary vasculitis P( <0.01). Anti-MPO and pANCA had high specificity for other autoimmune diseases P( <0.01). Conclusions: ANCA has important guiding significance for vasculitis-related diseases. Therefore, it is important in the diag- nosis and treatment of this disease and has value in clinical practice. MeSH Keywords: Antibodies, Antineutrophil Cytoplasmic • Autoimmune Diseases • Vasculitis Full-text PDF: https://www.medscimonit.com/abstract/index/idArt/905880 2394 8 — 63 Indexed in: [Current Contents/Clinical Medicine] [SCI Expanded] [ISI Alerting System] This work is licensed under Creative Common Attribution- [ISI Journals Master List] [Index Medicus/MEDLINE] [EMBASE/Excerpta Medica] NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) 4312 [Chemical Abstracts/CAS] [Index Copernicus] Tan L. et al.: Analysis of antineutrophil cytoplasm antibody from 118 730 patients… CLINICAL RESEARCH © Med Sci Monit, 2017; 23: 4312-4320 Background Affiliated Hospital of Nanchang University, 18 cases from Jiangxi Provincial People’s Hospital, 1630 cases from Jiangxi Provincial Antineutrophil cytoplasmic antibodies (ANCA) are autoimmune Hospital of Traditional Chinese Medicine, 3890 cases from the antibodies against neutrophil cytoplasmic components, and Fourth Affiliated Hospital of Nanchang University, 6510 cases has become a specific serological marker antibody for system- from the Affiliated Hospital of Jiujiang University, 8480 cases ic vasculitis represented by Wegener’s granulomatosis (WG) from Yichun People’s Hospital of Jiangxi Province, 10 070 cas- in recent years. ANCA, as an important serological diagnosis es from the Affiliated Hospital of Gannan Medical University, of vasculitis, is widely recognized by the medical profession 7580 cases from Ganzhou People’s Hospital of Jiangxi Province, for its usefulness in assessing the remission and recurrence and 5060 cases from Pingxiang People’s Hospital of Jiangxi status of diseases. Province. There were 41 633 men and 77 097 women in total and the ratio of males to females was 1: 1.85. Ages ranged ANCA is divided into cANCA and pANCA, and the matrix tab- from 1 to 109 years old, with an average of 51.5±12.1 years. lets for detection of ANCA include ethanol-immobilized neu- Positive results appeared in 5853 cases, in which 2053 were trophils, formalin-fixed neutrophils, HEP-2 cells, and monkey vasculitis, including Wegener’s granuloma (696 cases), micro- liver tissues, the latter 2 are mainly to exclude ANA interfer- vascular polyvascular (659 cases), eosinophilic granulomatous ence in the detection. The main target antigen of pANCA is vasculitis (173 cases), nodular polyarteritis (251 cases), aor- anti-myeloperoxidase (MPO). MPO is a highly cationic protein ta arteritis (121 cases), IgA vasculitis (53 cases), and Behçet’s with a molecular weight of 146 000, which can cause contin- disease (54 cases). Among the positive cases, 3612 had oth- uous ribbon fluorescence in the periphery of neutrophils. The er autoimmune diseases, including 54 cases of autoimmune main target antigen of cANCA is anti-protease 3 (PR3), which hepatitis, 115 cases of primary biliary cirrhosis, 98 cases of can cause the whole cytoplasmic region of neutrophils to cov- primary sclerosing cholangitis, 825 cases of rheumatoid ar- er coarse particles. thritis, 1182 cases of systemic lupus erythematosus, 565 cas- es of ulcerative colitis, 404 cases of mixed connective tissue Primary vasculitis is a not yet clear etiology of a class of small disease, 82 cases of scleroderma, 287 cases of Sjögren’s syn- vasculitis, mainly violations of small blood vessels, such as drome, 75 cases of type 2 diabetes mellitus, and 188 cases of small arteries, arteries, vascular wall necrosis inflammation, other types of diseases. We selected 100 healthy participants cellulose-like necrosis as a pathological feature, is a class of as the control group. Written informed consent was obtained sexually transmitted autoimmune diseases. Primary vasculi- from all subjects. The diagnosis of vasculitis was based on the tis generally refers to microscopic multiple vasculitis (MPA), diagnostic criteria of vasculitis [1], and rheumatoid arthritis Wegener’s granulomatosis (WG), Churg-Strauss syndrome (CSS), and systemic lupus erythematosus and other autoimmune dis- and primary necrosis crescentic glomerulonephritis (NCGN). eases were diagnosed according to the standards established Clinically, WG, MPA, CSS, NCGN, and other series of diseas- by the American Society of Rheumatology (ACR) [2]. All speci- es are called ANCA-related systemic vasculitis (AASV). AASV mens were obtained with the patient’s informed consent and is a kind of small vascular wall inflammation and/or fibrinoid approved by the Hospital Ethics Committee. necrosis, and is the pathological basis of a group of autoim- mune diseases, mainly involving systemic small vessel auto- Instruments and reagents immune disease, and is the most common adult primary vas- culitis. ANCA and its target antigen are widely used in clinical Many types of fluorescence microscopes were used, including practice, and the incidence of AASV is increasing. In this pa- EUPOStar Plus, Nikon, and OLYMPUS BX. Microplate readers per, the results of ANCA testing in 118 730 cases in tertiary used included SUNRISE, ELX 808, and Multiscan MK3. Washing care hospitals in Jiangxi Province, China, from January 2014 to machines used included PW-960 automatic, ELX 50, and BioTek December 2016 were retrospectively analyzed. automatic. Reagents used were the antineutrophil cytoplas- mic IgG test kit, Anti-MPO assay kit, and the anti-PR3 assay kit provided by EUROIMMUN (Germany). Material and Methods Methods Review of the cases ANCA fluorescence pattern was determined by IIF meth- Retrospective statistical analysis was completed in tertia- od. Reagents were purchased from EUROIMMUN Company ry (3A) hospitals of Jiangxi Province from January 2014 to (Germany). The reaction areas included HEp-2 cells, primate December 2016. Of the total of 118 730 cases with ANCA test liver tissue, and formaldehyde- and ethanol-fixed human neu- results, there were 23 720 cases from the Second Affiliated trophils. Samples were diluted with PBST buffer for 1: 10 di- Hospital of Nanchang University, 33 770 cases from the First lution
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