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World J Gastroenterol. Jan 28, 2008; 14(4): 622-626
Published online Jan 28, 2008. doi: 10.3748/wjg.14.622
Significance of antineutrophil cytoplasmic antibody in adult patients with Henoch-Schönlein purpura presenting mainly with gastrointestinal symptoms
Yan Zhang, Yong-Kang Wu, Matthew A Ciorba, Qin Ouyang
Yan Zhang, Qin Ouyang, Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Yong-Kang Wu, Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Matthew A Ciorba, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO 63110, United States
Correspondence to: Qin Ouyang, MD, Division of Gastro-enterology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China. fengyixx@sohu.com
Telephone: +86-28-85422385
Fax: +86-28-85501219
Received: August 5, 2007
Revised: November 14, 2007
Published online: January 28, 2008

AIM: To test the clinical significance of antineutrophil cytoplasmic antibody (ANCA) in evaluation of adult Henoch-Schönlein purpura (HSP) patients presenting mainly with abdominal symptoms.

METHODS: Twenty-eight consecutive HSP patients who presented predominantly with abdominal symptoms were enrolled in this study. Control subjects included 27 age- and sex-matched patients with peptic ulcer disease, colon cancer, acute gastroenteritis, irritable bowel syndrome and colonic polyps. ANCA was measured by indirect immunofluorescence (IIF) in all patients, and follow-up ELISA was performed in patients with positive IIF tests.

RESULTS: ANCA was detected in 9 HSP patients by IIF (2 were positive for c-ANCA and 7 were positive for p-ANCA). No ANCA was found in the control group. The sensitivity and specificity of a positive ANCA test (either c- or p-ANCA) were 32.1% and 100% respectively. Only one out of the 9 patients with positive ANCA by IIF had positive ANCA by ELISA and the antigen was myeloperoxidase (MPO). The patients positive for ANCA had higher HSP clinical scores, and were more likely to have renal function impairment. Patients with late purpura development were also associated with more severe clinical manifestations.

CONCLUSION: A positive ANCA test is associated with more severe symptoms in HSP. After inflammatory bowel disease is excluded, a positive ANCA test provides a clue to the diagnosis of HSP presenting predominantly with abdominal symptoms.

Keywords: Henoch-Schönlein purpura, Antineutrophil cytoplasmic antibody, Diagnosis, Indirect immuno-fluorescence