CAJ | 학술논문

目的：探讨Graves病患者在治疗的不同阶段和不同方法时中性粒细胞胞浆抗体（ANCA）检测的临床意义。方法本组Graves病患者197例，分为初发未治疗组（n=43）、丙基硫氧嘧啶组（PTU组，n=46）、甲巯咪唑组（MMI组， n=68）和同位素碘131（I131组，n=40），应用间接免疫荧光法（IIF）检测血清，对ANCA和抗核抗体（ANA）IIF检测阳性者进一步应用酶联免疫吸附（ELISA）法检测血中ANCA靶抗原，即髓过氧化酶（MPO）和抗蛋白酶3（PR3）。结果初发未治疗组IIF阳性者占4.7%（2/43），均为IIF-ANA阳性；PTU组IIF阳性者占19.6%（9/46），均为IIF-ANCA阳性；MMI组IIF阳性者占4.4%（3/68），均为IIF-ANA阳性；I131组IIF阳性者占5.0%（2/40），均为IIF-ANCA阳性。PTU组IIF-ANCA的阳性率高于初发未治疗组（P<0.01）、MMI组（P<0.01）和I131组（P<0.05）。16例IIF阳性患者中3例出现血管炎相关症状，3例均识别MPO，其中1例识别PR3。结论 Graves病患者检测ANCA阳性与PTU治疗相关，Graves病患者在予PTU治疗过程中需重视ANCA的检测。
목적：탐토Graves병환자재치료적불동계단화불동방법시중성립세포포장항체（ANCA）검측적림상의의。방법본조Graves병환자197례，분위초발미치료조（n=43）、병기류양밀정조（PTU조，n=46）、갑구미서조（MMI조， n=68）화동위소전131（I131조，n=40），응용간접면역형광법（IIF）검측혈청，대ANCA화항핵항체（ANA）IIF검측양성자진일보응용매련면역흡부（ELISA）법검측혈중ANCA파항원，즉수과양화매（MPO）화항단백매3（PR3）。결과초발미치료조IIF양성자점4.7%（2/43），균위IIF-ANA양성；PTU조IIF양성자점19.6%（9/46），균위IIF-ANCA양성；MMI조IIF양성자점4.4%（3/68），균위IIF-ANA양성；I131조IIF양성자점5.0%（2/40），균위IIF-ANCA양성。PTU조IIF-ANCA적양성솔고우초발미치료조（P<0.01）、MMI조（P<0.01）화I131조（P<0.05）。16례IIF양성환자중3례출현혈관염상관증상，3례균식별MPO，기중1례식별PR3。결론 Graves병환자검측ANCA양성여PTU치료상관，Graves병환자재여PTU치료과정중수중시ANCA적검측。
Objective To investigate the clinical significance of neutrophil cytoplasmic antibody(ANCA)in Graves disease at different stages and treated with different methods. Methods 197 cases of outpatient and inpatient patients with Graves disease were divided into untreated group(n=43),propylthiouracil group(PTU)(n=46),a hydrophobic imidazole group(MMI)(n=68) and isotope iodine 131(I131)group(n=40). To test the serum of patients by indirect immunofluorescence(IIF),further test blood ANCA target antigens that myeloperoxidase(MPO)、anti-proteinase 3(PR3)for ANCA and anti-nuclear antibody(ANA) IIF test positive patients by enzyme-linked immunosorbent assay(ELISA). Results ①untreated group,IIF was positive in 4.7%(2/43),were IIF-ANA positive;PTU group,IIF was positive in 19.6%(9/46),were IIF-ANCA positive;MMI group,IIF was positive in 4.4%(3/68),were IIF-ANA positive;I131 group,IIF was positive in 5%(2/40),were IIF-ANCA positive. The positive rate of IIF-ANCA in PTU group was higher than that of untreated group(P<0.01);higher than the MMI group(P<0.005);higher than the I131 group(P<0.05),there was significant difference. The 3/16 IIF positive patients had vasculitis associated symptoms,3 cases were identified MPO,including 1 cases of PR3 recognition. Conclusion ANCA-positive patients with Graves disease were associated with PTU treatment,Graves patients should be paid attention to the detection of ANCA during PTU treatment.