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Hellmich B, Löffler C. [What are the indications for rescue procedures? : Systemic rheumatic diseases in the intensive care unit]. Z Rheumatol 2019; 78:955-966. [PMID: 31485728 PMCID: PMC7101899 DOI: 10.1007/s00393-019-00687-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Schwere, organ- oder lebensbedrohliche Manifestationen entzündlicher rheumatischer Erkrankungen, wie z. B. eine diffuse alveoläre Hämorrhagie im Rahmen einer Kleingefäßvaskulitis, sprechen nicht immer ausreichend oder mit zeitlicher Verzögerung auf eine immunsuppressive Therapie an. Bei einem drohenden oder bereits eingetretenen Organversagen besteht dann nicht selten die Notwendigkeit, die immunsuppressive Therapie auf der Intensivstation um rasch wirksame Rescue-Therapieverfahren zu ergänzen. Aufgrund der Seltenheit vieler rheumatischer Erkrankungen ist die Evidenz zum Einsatz von Rescue-Therapieverfahren wie der Plasmapherese, der extrakorporalen Membranoxygenierung (ECMO) oder der Gabe von intravenösen Immunglobulinen (IVIG) für viele Indikationen eher gering. Der Einsatz der Plasmapherese wird bei einer akuten Anti-GBM(glomeruläre Basalmembran)-Erkrankung (Goodpasture Syndrom) oder einem katastrophalen Antiphospholipidantikörpersyndrom (CAPS) als sinnvoll angesehen. Eine ECMO-Therapie kann bei persistierender respiratorischer Insuffizienz trotz mechanischer Beatmung als Folge einer diffusen alveolären Hämorrhagie oder eines Acute-Respiratory-Distress-Syndroms (ARDS) anderer Ursache erwogen werden. Eine Gabe von IVIG ist bei einer akuten kardialen Beteiligung im Rahmen einer Kawasaki-Erkrankung indiziert und kann beim CAPS sowie bei therapierefraktären Myositiden erwogen werden.
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Affiliation(s)
- B Hellmich
- Vaskulitiszentrum Süd, Klinik für Innere Medizin, Rheumatologie und Immunologie, Medius Kliniken - Akademisches Lehrkrankenhaus, Universität Tübingen, Eugenstr. 3, 73230, Kirchheim u. Teck, Deutschland.
| | - C Löffler
- Vaskulitiszentrum Süd, Klinik für Innere Medizin, Rheumatologie und Immunologie, Medius Kliniken - Akademisches Lehrkrankenhaus, Universität Tübingen, Eugenstr. 3, 73230, Kirchheim u. Teck, Deutschland
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Tan L, Jiao A, Chen J, Feng X, Xu L, He S, Tan F, Jiang Y, Luo H, Li H, Wu Y, Tian Y, Zeng T, Yu J, Cao L, Zheng J, Xu H, Wei M, Gan W, Peng W, Liu Y, Hou J, Xu J, Shuai L, Huang W, Huang J, Lin Y, Liu J. Analysis of Antineutrophil Cytoplasm Antibody from 118 730 Patients in Tertiary Hospitals in Jiangxi Province, China. Med Sci Monit 2017; 23:4312-4320. [PMID: 28878204 PMCID: PMC5600193 DOI: 10.12659/msm.905880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/13/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The discovery of antineutrophil cytoplasm antibody (ANCA) makes the early diagnosis of primary vasculitis possible, 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 AND 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 differences (χ²=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 diagnosis and treatment of this disease and has value in clinical practice.
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Affiliation(s)
- Liming Tan
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Anjun Jiao
- School of Public Health, Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Juanjuan Chen
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Xiaojing Feng
- School of Public Health, Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Liuyue Xu
- School of Public Health, Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Siqi He
- School of Public Health, Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Fuyan Tan
- School of Public Health, Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Yongqing Jiang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Heng Luo
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Hua Li
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Yang Wu
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Yongjian Tian
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Tingting Zeng
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Jianlin Yu
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Liping Cao
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Jianfeng Zheng
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Hui Xu
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Ming Wei
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Wen Gan
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Weihua Peng
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Yanming Liu
- Department of Clinical Laboratory, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, P.R. China
| | - Jing Hou
- Department of Clinical Laboratory, Jiangxi Provincial Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi, P.R. China
| | - Jiangxia Xu
- Department of Clinical Laboratory, The Fourth Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - LiHua Shuai
- Department of Clinical Laboratory, The Affiliated Hospital of Jiujiang University, Jiujiang, Jiangxi, P.R. China
| | - Wenzhi Huang
- Department of Clinical Laboratory, Yichun People’s Hospital of Jiangxi Province, Yichun, Jiangxi, P.R. China
| | - Junyun Huang
- Department of Clinical Laboratory, The Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, P.R. China
| | - Yan Lin
- Department of Clinical Laboratory, Ganzhou People’s Hospital of Jiangxi Province, Ganzhou, Jiangxi, P.R. China
| | - Jianrong Liu
- Department of Clinical Laboratory, Pingxiang People’s Hospital of Jiangxi Province, Pingxiang, Jiangxi, P.R. China
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