最新自己抗体検査(3)

抗好中球細胞質抗体( ANCA )

吉　田　雅　治*
　　　　　　　　　　　　　　　　　　　　　　
Antineutrophil Cytoplasmic Antibody(ANCA)

Masaharu YOSHIDA*

ANCA are associated with small sized vessel vasculitis; one subtype is an antibody against myeloperoxidase(MPO), which stains in a perinuclear pattern(P-ANCA) indirect immunofluorescence(IIF) using a neutrophil substrate, and the other subtype is an antibody against proteinase-3(PR-3), which stains in a diffuse granular cytoplasmic pattern ANCA by IIF. PR-3 ANCA is more specific in Wegener’s granulomatosis(WG) than the other primary vasculitides. MPO-ANCA can be found in microscopic polyangiitis (MPA), Churg Strauss Syndromes(CSS), drug-induced vasculitis, and environmental factor-induced such as silicosis vasculitis more frequently than WG. The value of the IIF test for ANCA detection can be greatly increased by the addition of a standardized antigen-specific ELISA. The intra-assay and inter-assay CV of the MPO and PR-3 ELISA were 6.6 to 4.8%, respectively. Close ANCA titer correlation was shown between MPO-ANCA ELISA and the activity of ANCA associated vasulitis. Renal manifestations and pulmonary manifestations are observed in 70-90% of AAV as the initial manifestation. The changes in titers of ANCA seem to reflect disease activity in 60-70% of AAV patients. A combination of steroids and immunosuppressive drugs is effective in relieving the clinical symptoms of AAV.
[Rinsho Byori 51 : 644〜648, 2003]

*The Department of Nephrology, Hachioji Medical Center of Tokyo Medical University, Hachioji 193-0998

【Key Words】C(PR-3) ANCA，P(MPO)-ANCA(抗好中球細胞質抗体)，small vessel vasculitis(小型血管炎)，Wegener’s granulomatosis(ウェゲナー肉芽腫症)，microscopic polyangitis(顕微鏡的多発血管炎)

*東京医科大学八王子医療センター腎臓科(〒193-0998 八王子市館町1163)

E-mail :myoshida@tokyo-med.ac.jp