Clinical Application Of Antineutrophil Cytoplasmic Antibodies On Thromboangiitis Obliterans (Buerger's Disease)

Objective: To investigate the presence of Anti-Neutrophil Cytoplasmic Antibodies (ANCA) and their specificity to proteinase3,myeloperoxidase,cathepsin G,bactericidal/permesbility-increasing protein,elastase and lactoferrin were studied in 23 patients with thromboangiitis obliterans (Buerger's disease,TAO).Methods: The TAO group includes 23 patients who are identified thromboangiitis obliterans. Including 8 in mild stage of the disease (group I) and 15 in active or severe stage (group II). The arteriosclerosis obliterans (ASO) group including 25 pantients as the same symptom as TAO and the control group is health group including 25 volunteers. Serum samples were investigated for ANCA prevalence by indirect immunofluorescent technique in TAO group,ASOgroup and health group. the reactivity to proteinase 3(PR3) , myeloperoxidase(MPO) , cathepsin G(CG) ,bactericidal/permesbility-increasing protein(BPI) , elastase(HLE) and lactoferrin(LF) was measured by ELISA in TAO group and health group. Results: (1) There are 13 of 23 patients with TAO who are tested ANCA positive by indirect immunofluorescence, the ANCA prevalence is 52.2%,they are all pANCA. No cANCA is found. Only one patient is pANCA positive among 25 patients with ASO,the prevalence is 4%,and no ANCA are found in healthy controls. The difference is significant to the prevalence of ANCA positivity in TAO patients versus which in healthy controls and ASO group(P < 0.05). (2) ANCA were predominantly found in group II (66.7%; 12/18) compared to group I (33.3%; 3/9) and the levels of the titre of ANCA in the group II was higher than group I. The results are statistical significance (P < 0.05). (3) Only five of 12 ANCA-positive sera reacted with MPO,three of the twelve reacted with LF,one serum is HLE positive and one is BPI positive. No serum reacted with PR3 and CG. (4) Anti-MPO, anti-LF,anti-BPI and anti-HLE autoantibodies were found only in the severe group. Sera from the severe group versus those from the mild group of TAO and the health control,the differences in mean OD index to MPO, LF,HLE and BPI are statistically significan (P < 0.05). (5)The age,duration,age on set of the patients with TAO have not statistically significant differences between group I and group II.Conclusion: The prevalence of ANCA and levels of Anti-MPO, anti-LF,anti-BPI and anti-HLE correlated with disease severity. Therefore, detection of ANCA can be a helpful serological test for the diagnosis of thromboangiitis obliterans.