Evaluation of the efficiency of methods of diagnostics of various variants of granulomatosis with polyangiitis

Аннотация

Early diagnosis of granulomatosis with polyangiitis (GPA) is a difficult clinical task and requires a thorough examination of the patient using modern research methods to identify pathognomonic symptoms. It is necessary to specifically search for respiratory tract damage by performing rhinoscopy, laryngoscopy, computer tomography of the paranasal sinuses, and lung scans, as the disease may be asymptomatic or have minimal clinical symptoms for a long time. Only 50% of patients are diagnosed within the first 3-6 months of disease onset, while in 7%, GPA remains undetected for 5-16 years after the first symptoms appear. In the active period of the disease, non-specific signs are revealed in the laboratory examination: normochromic anemia, thrombocytosis, neutrophilic leukocytosis and an increase in ESR, rheumatoid factor, positivity of C- reactive protein. Clinical analysis of urine: hematuria, erythrocyte casts, proteinuria. Along with the urinary syndrome, azotemic indicators increase and the glomerular filtration rate decreases rapidly. Keywords: Granulomatosis with polyangiitis, diagnosis, ANCA. remission and may not be detected in relapses despite Introduction: ANCA is a group of immunoglobulin G high vasculitis activity. Although high ANCA activity is (IgG) antibodies directed against the cytoplasm of common in GPA, ANCA is unlikely to be a major factor neutrophil granulocytes and monocytes, the presence in the development of the disease [8-11]. In systemic of which in blood serum can be detected indirectly by GPA, c-ANCA is found in approximately 90% of patients, immunofluorescence. In PAG, antigens are detected for and in 80-95% of these patients, antibodies are proteinase 3 (PR3) and myeloperoxidase (MPO). ANCA directed against PR3. c-ANCA has a sensitivity of 91% against these antigens is therefore called PR3-ANCA and specificity of 99% for active GPA. and MPO-ANCA. The detection of ANCA is important. Among serological methods for the detection of ANCA, Purpose: To evaluate the effectiveness of methods of immunofluorescence and enzyme-linked diagnosis of various variants of polyangiitis immunosorbent assays are widely used. In indirect granulomatosis immunofluorescence in the presence of ethanol-fixed METHODS neutrophils, antibodies specific for proteinase-3 and The study subjects were 60 patients with GPA who myeloperoxidase produce different fluorescences: they were treated inpatiently in the rheumatology and are c-ANCA (cytoplasmic antineutrophil cytoplasmic cardiorheumatology departments of the antibodies) and p-ANCA (perinuclear antineutrophil Multidisciplinary Clinic of the Tashkent Medical cytoplasmic antibodies). c-ANCA is mainly associated Academy in 2018-2022 and who were monitored and with serum containing PR3-ANCA and is specific for treated on an outpatient basis in the arthrological IADC PAH (>90%). c-ANCA has a sensitivity of 91% and department. specificity of 99% for active HPA [1-7]. However, ANCA is an important diagnostic marker of PAH and has a low The subjects of the study included patients' blood value for monitoring disease activity, because they can serum, radiological and ultrasound examination be present in the serum during complete clinical methods, as well as materials for determining the level International Journal of Medical Sciences And Clinical Research 40 https://theusajournals.com/index.php/ijmscr International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265) of disease activity (BVAS) and determining the compared. vasculitis damage index (VDI). The BVAS scale (Bermingham Vasculitis Activity Index) The study used a clinical questionnaire, laboratory was used to assess activity. Remission of the disease tests, immunological (ANCA), nasopharyngeal was considered to be a BVAS score of 1 or less, and bacteriological culture, BVAS and VDI indicators, exacerbation of GPA was considered to be a BVAS score instrumental (paranasal sinus and lung CT, X-ray of 2 or more. Organ damage was assessed in all patients examination) and statistical methods. using the VDI index. The damage index takes into account the organ damage observed since the onset of General examination of patients was carried out vasculitis. Patients often have additional diseases that according to the plan adopted in the clinic. During the arose before the development of vasculitis, which study of the anamnesis, special attention was paid to should not be taken into account. the activity of the disease, the presence of damage to various organs and systems. RESULTS In the detailed anamnesis study, the premorbid Patients with exacerbation of GPA had significantly background more than 6 months before the onset of higher erythrocyte sedimentation rate and C-reactive GPA and the conditions that preceded the appearance protein levels compared with patients in remission of of GPA symptoms and could cause its development GPA. The main laboratory parameters are presented in were analyzed. Manifest sy