ANCA血清学对肾脏受累的ANCA相关性血管炎的诊断准确性。

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL Internal Medicine Journal Pub Date : 2024-06-14 DOI:10.1111/imj.16436

Adrienne Cohen, Nethmi Weerasinghe, Karla Lemmert, Theo de Malmanche, Thida Myint

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引用次数: 0

摘要

背景：抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）导致的保济免疫性肾小球肾炎（GN）是新月体GN的常见病因。尽管治疗取得了进展，但死亡率和发展为终末期肾病的比例仍然很高。肾脏受累可通过肾组织的组织学检查确诊。目的：我们旨在评估血清 ANCA 滴度在诊断肾脏受累的 AAV 中的诊断准确性：我们对本中心从 2016 年至 2021 年报告的连续原位肾活检进行了回顾性研究。我们纳入了所有同时接受肾活检和 ANCA 血清学检查的成人。ANCA 血清学检测采用间接免疫荧光法，并报告滴度。蛋白酶 3 和髓过氧化物酶抗体采用化学发光免疫测定法进行检测：研究期间共报告了 848 例原生肾活检病例。结果：在研究期间，共报告了 848 例原生肾活检病例，其中纳入了 577 例。配对样本中，41/507（8.1%）的活组织检查结果显示存在贫免疫性 GN。大多数病例有血尿（66.6%）、蛋白尿（93.4%）和/或急性肾损伤（65.0%）。任何滴度的 ANCA 阳性对诊断贫免疫性 GN 的敏感性为 97.6%，特异性为 71.2%。接受者操作特征曲线下面积为 0.93（95% 置信区间 [CI]：0.89-0.97）。ANCA滴度的临界值为1:160，在灵敏度75.6%（95% CI：59.7%-87.6%）和特异度94.0%（95% CI：91.6%-96.0%）之间实现了最佳平衡：结论：在适当的情况下，ANCA滴度可高度预测弱免疫性GN。虽然血清 ANCA 定量不能取代肾活检，但报告有助于决定是否及早对患有器官疾病或生命垂危的患者开始治疗。

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Diagnostic accuracy of ANCA serology in ANCA-associated vasculitis with renal involvement

Background

Pauci-immune glomerulonephritis (GN) due to antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a common cause of crescentic GN. Despite advances in treatment, rates of mortality and progression to end-stage kidney disease remain high. Renal involvement is diagnosed by histological examination of kidney tissue. Serum ANCAs play a significant role in AAV; however, the value of serum ANCA quantification to predict renal involvement is not well-established.

Aim

We aimed to evaluate the diagnostic accuracy of serum ANCA titres in diagnosing AAV with renal involvement.

Methods

We conducted a retrospective study of consecutive native kidney biopsies reported at our centre from 2016 to 2021. We included all adults who had both a kidney biopsy and ANCA serology. ANCA serology was tested using indirect immunofluorescence with reporting of titres. Antibodies to proteinase 3 and myeloperoxidase were measured using a chemiluminescent immunoassay.

Results

Eight hundred and forty-eight native kidney biopsies were reported during the study period. Five hundred and seven cases were included. The biopsy prevalence of pauci-immune GN in paired samples was 41/507 (8.1%). Most of the cohort had haematuria (66.6%), proteinuria (93.4%) and/or acute kidney injury (65.0%). A positive ANCA at any titre demonstrated a sensitivity of 97.6% and a specificity of 71.2% for a diagnosis of pauci-immune GN. The area under the curve for the receiver operator characteristic was 0.93 (95% confidence interval [CI]: 0.89–0.97). A cutoff ANCA titre of 1:160 provided the optimum balance between a sensitivity of 75.6% (95% CI: 59.7%–87.6%) and a specificity of 94.0% (95% CI: 91.6%–96.0%).

Conclusions

ANCA titres are highly predictive of pauci-immune GN in the appropriate context. While serum ANCA quantitation may not replace renal biopsy, reporting will assist in the decision to start treatment early for patients with organ or life-threatening disease.

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来源期刊

Internal Medicine Journal 医学-医学：内科

CiteScore

3.50

自引率

4.80%

发文量

600

审稿时长

3-6 weeks

期刊介绍： The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.