Relationship between ANCA and clinical activity in inflammatory bowel disease: variation in prevalence of ANCA and evidence of heterogeneity

Antineutrophil cytoplasmic antibodes (ANCA) are markers of necrotizing vasculitis. ANCA have been recently detected in the two forms of inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn's disease (CD). To assess the possible role of ANCA in the diagnosis and management of IBD we studied the prevalence of ANCA at diagnosis and during follow-up in a group of 89 IBD patients. The relationship between ANCA and clinical features of IBD was investigated. ANCA assayed by indirect immunofluorescence were detected in 38/52 (73%) of the UC patients but only 6/37 (16.6%) of the CD patients (P<0.005) and in none of the controls. In the UC group, but not in the CD group, there was a positive correlation between ANCA and disease activity. The sensitivity and specificity of ANCA for the diagnosis of UC were 73 and 83.7% respectively. The most commonly observed pattern of ANCA in IBD patients was perinuclear: in 84% of the UC and 66.6% of the CD patients positive for ANCA, respectively. However, careful comparison of IFL patterns revealed some distinct features of IBD-associated ANCA when compared to vasculitis-associated ANCA. In addition, most ANCA positive sera from IBD patients were negative for antibodies to proteinase 3 and myeloperoxidase by ELISA. These results suggest that the autoantigens recognized by ANCA are different in patients with IBD from those with necrotising vasculitis.

[Tumor necrosis factor-alpha in human immunodeficiency virus infection]

BACKGROUND

The aim of the present was to determine the levels of the tumor necrosis factor (TNF)-alpha in patients with HIV infection to study the relationship with the concentration of triglycerides (TG), CD4 lymphocyte count and clinical diagnosis.

METHODS

Seventy-eight HIV-infected patients (58 males, 20 females); mean age 32 years presenting different clinical situations were studied. TNF, TG, CD4 lymphocyte count, and clinical diagnosis at the time of the study were analyzed.

RESULTS

The mean TNF values in the sample was 25.5 x 10(-3) pg/l with a confidence interval of 95% (Cl 95%), 16.6 x 10(-3) pg/l to 34.4 x 10(-3) pg/l with a trend to being higher in the group with less than 200 x 10(6) CD4/l (Cl 95%: 18.6 x 10(-3) pg/l-44.3 x 10(-3) pg/l). Mean TG values in the sample were 2.02 milligrams (Cl 95%: 1.72 milligrams-2.31 milligrams) being significantly higher in the group with less than 200 x 10(6) CD4/l (X = 2.35 +/- 1.32 milligrams; p < 0.005). TNF concentrations were found to be significantly higher in the group with acute infection (Cl 95%: 27 x 10(-3) pg/l-69 x 10(-3) pg/l) with respect to the group without infection at the time of the study (Cl 95% 7 x 10(-3) pg/l-19 x 10(-3) pg/l). The correlation coefficient between TNF and TG was r = 0.34 (p = 0.01).

CONCLUSIONS

Both the tumor necrosis factor and triglycerides are high in patients with HIV infection and CD4 lower than 200 x 10(6)/l. The correlation between tumor necrosis factor and triglyceride concentrations is positive and significant. The increase in the former is more important when there is concomitant infection and could be considered as a marker of opportunistic infection.

Anti-neutrophil cytoplasmic auto-antibodies-associated vasculitis with pulmonary and renal involvement

We present a 13-year-old boy with a rapidly progressive glomerulonephritis and pulmonary haemorrhage with perinuclear anti-neutrophil cytoplasmic auto-antibodies (pANCA) corresponding to anti-myeloperoxidase antibodies. The diagnosis of microscopic polyarteritis was made on the basis of the clinical features, the positivity of pANCA, and the histological finding of a pauci-immune crescentic glomerulonephritis. He responded excellently to corticosteroids and cyclophosphamide therapy and complete clinical remission persists 1 year after withdrawal of treatment. We emphasize the usefulness of ANCA antibody assays to establish a prompt diagnosis and adequate treatment in systemic vasculitis in children.

Renal function changes in microalbuminuric normotensive type II diabetic patients treated with angiotensin-converting enzyme inhibitors

OBJECTIVE

To determine the effects of captopril on microalbuminuria and renal function in normotensive type II diabetic patients.

RESEARCH DESIGN AND METHODS

A total of 26 patients were randomized in two homogeneous groups for clinical and analytical data in a 6-mo follow-up study. Group A received captopril (initial dose: 12.5 mg daily, increased according to tolerance); group B was untreated.

RESULTS

Microalbuminuria decreased only in the treated group at 6 mo (P = 0.044) and a significant (P = 0.027) mean percentage change on microalbuminuria excretion between the groups was observed. Filtration fraction decreased in group A (baseline: 0.23 +/- 0.03; 6 mo: 0.22 +/- 0.04) and increased in group B (baseline: 0.22 +/- 0.04; 6 mo: 0.25 +/- 0.04) with a significant mean percentage change between the groups at 6 mo (P = 0.032). The mean percentage change in microalbuminuria was significantly correlated with a mean percentage change in diastolic blood pressure throughout the trial. Neither metabolic control nor sodium or protein intake changed in either group during the trial.

CONCLUSIONS

These results suggest that captopril can help arrest microalbuminuria in normotensive type II diabetic patients, with a decrease in diastolic blood pressure and filtration fraction after a 6-mo treatment.

LDH isoenzymes in the T lymphocytes of patients with primary hypogammaglobulinaemia

A fetal lactate dehydrogenase (LDH) isoenzyme pattern, with relative deficiency of LDH1, was found in enriched T cell preparations from patients with late onset and X-linked hypogammaglobulinaemia. This provides further evidence that such T cells are 'immature'.