{"id":9145,"date":"2020-04-23T03:29:24","date_gmt":"2020-04-23T00:29:24","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/anticorpi-anti-citoplasma-neutrofile-imunofluorescenta\/"},"modified":"2025-02-06T13:43:45","modified_gmt":"2025-02-06T11:43:45","slug":"anticorpi-anti-citoplasma-neutrofile-anca-imunofluorescenta","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/anticorpi-anti-citoplasma-neutrofile-anca-imunofluorescenta\/","title":{"rendered":"\u0410\u043d\u0442\u0438\u043d\u0435\u0439\u0442\u0440\u043e\u0444\u0438\u043b\u044c\u043d\u044b\u0435 \u0446\u0438\u0442\u043e\u043f\u043b\u0430\u0437\u043c\u0430\u0442\u0438\u0447\u0435\u0441\u043a\u0438\u0435 \u0430\u043d\u0442\u0438\u0442\u0435\u043b\u0430 (ANCA) - \u0438\u043c\u043c\u0443\u043d\u043e\u0444\u043b\u0443\u043e\u0440\u0435\u0441\u0446\u0435\u043d\u0446\u0438\u044f"},"content":{"rendered":"<p style=\"text-align: justify;\"><strong><em>\u041e\u0431\u0449\u0430\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f<\/em><\/strong><\/p>\n<p style=\"text-align: justify;\">Anticorpii ANCA au fost descri\u015fi pentru prima dat\u0103 \u00een 1982 la pacien\u0163i cu glomerulonefrit\u0103 de natur\u0103 autoimun\u0103.<\/p>\n<p style=\"text-align: justify;\">ANCA sunt\u00a0anticorpi (de tip IgG, mai rar IgA \u015fi IgM) \u00eendrepta\u0163i \u00een principal \u00eempotriva antigenelor din citoplasm\u0103 granulocitelor neutrofile (\u0163intele moleculare fiind enzimele din granula\u0163iile primare sau azurofile ale granulocitelor neutrofile) \u015fi monocitelor<sup>1;4;5<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Utiliz\u00e2nd ca substrat neutrofile fixate cu etanol, la examenul prin imunofluorescen\u0163\u0103 indirect\u0103 au fost descrise 3 pattern-uri principale:<\/p>\n<ul style=\"text-align: justify;\">\n<li>\n<div><strong><span style=\"text-decoration: underline;\">citoplasmatic (c-ANCA<\/span><\/strong><strong>)<\/strong>, caracterizat prin fluorescen\u0163a granular\u0103 citoplasmatic\u0103 difuz\u0103, cu accentuare central\u0103 interlobular\u0103; antigenul este reprezentat de <span style=\"text-decoration: underline;\">proteinaza3 (PR3)<\/span>, un component atat al granula\u0163iilor azurofile din celulele mieloide, c\u00e2t \u015fi al lizozomilor monocitari;<\/div>\n<\/li>\n<li>\n<div><strong><span style=\"text-decoration: underline;\">perinuclear (p-ANCA<\/span><\/strong><strong>)<\/strong>, caracterizat prin fluorescen\u0163a perinuclear\u0103 (inelar\u0103) omogen\u0103, f\u0103r\u0103 fluorescen\u0163\u0103 citoplasmatic\u0103; principalul antigen este <span style=\"text-decoration: underline;\">mieloperoxidaza (MPO)<\/span>, o protein\u0103 a granula\u0163iilor neutrofile implicat\u0103 \u00een procese metabolice cum ar fi generarea de radicali de oxigen. Acest pattern apare datorit\u0103 migr\u0103rii antigenelor \u00eenc\u0103rcate pozitiv (cationice) \u00een timpul fix\u0103rii cu etanol spre membrana nuclear\u0103 care este \u00eenc\u0103rcat\u0103 negativ. Atunci c\u00e2nd \u00een loc de etanol se utilizeaz\u0103 formalina pentru fixarea neutrofilelor, antigenul \u0163int\u0103 este imobilizat \u015fi se ob\u0163ine o fluorescen\u0163\u0103 citoplasmatic\u0103.<\/div>\n<\/li>\n<li>\n<div><strong><span style=\"text-decoration: underline;\">atipic ANCA (x-ANCA)<\/span><\/strong><strong>,\u00a0<\/strong>caracterizat prin fluorescen\u0163a perinuclear\u0103 neomogen\u0103; antigenele implicate sunt catepsina G, elastaza, lactoferina, catalaza, enolaza, lizozimul, BPI (proteina bacterid\u0103 care cre\u015fte permeabilitatea) sau alte antigene necunoscute. Spre deosebire de aspectul p-ANCA tipic, atunci c\u00e2nd \u00een loc de etanol se utilizeaz\u0103 formalina pentru fixarea neutrofilelor <span style=\"text-decoration: underline;\">nu<\/span> se ob\u0163ine fluorescen\u0163a<sup>4<\/sup>.<\/div>\n<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Au mai fost descri\u015fi <em>anticorpii GS-ANA (granulocyte-specific ANA = anticorpi anti-nucleari specifici granulocitelor) <\/em>care produc o fluorescen\u0163\u0103 nuclear\u0103 sau perinuclear\u0103 pe substratul fixat cu etanol, dar negativ\u0103 pe substrat Hep-2 \u015fi care apar la 20% dintre pacien\u0163ii cu artrit\u0103 reumatoid\u0103 (prezen\u0163a lor ar putea fi determinat\u0103 de ingestia complexelor imune de c\u0103tre neutrofile, antigenul \u0163int\u0103 nefiind \u00eenc\u0103 identificat)<sup>1<\/sup>.<\/p>\n<p style=\"text-align: justify;\">Anticorpii ANCA se depisteaz\u0103 predominant la pacien\u0163ii cu vasculit\u0103 sistemic\u0103 pauciimun\u0103, caracterizat\u0103 histologic prin necroza fibrinoid\u0103 prezent\u0103 \u00een pere\u0163ii venulelor, capilarelor \u015fi arteriolelor. Spre deosebire de vasculita mediat\u0103 prin complexe imune, \u00een vasculitele asociate cu ANCA lipsesc depozitele de complexe imune din peretele vascular, fiind prezente \u00een schimb, mai ales \u00een stadiile precoce de boal\u0103, polimorfonucleare. Afectarea endoteliului vascular, indus\u0103 de neutrofile, de\u0163ine de asemenea un rol important \u00een patogenia vasculitelor pauciimune.<\/p>\n<p style=\"text-align: justify;\"><span style=\"text-decoration: underline;\">Anticorpii c-ANCA<\/span> se asociaz\u0103 \u00een mod specific cu boala Wegener. In cazul unei boli active cu vasculit\u0103 sistemic\u0103, glomerulonefrita necrotizant\u0103 \u015fi inflama\u0163ie de tip granulomatos a tractului respirator, sensibilitatea clinic\u0103 a c-ANCA este de 85-90%.<\/p>\n<p style=\"text-align: justify;\">\u00cen lipsa afect\u0103rii renale sensibilitatea clinic\u0103 este de numai 75%. Titrul anticorpilor c-ANCA se coreleaz\u0103 cu gradul de activitate a bolii; dup\u0103 terapia imunosupresoare titrul anticorpilor scade foarte mult sau se ob\u0163ine un rezultat negativ. c-ANCA mai pot ap\u0103rea \u00een poliangeita microscopic\u0103 \u015fi in sindromul Churg-Strauss, \u00eens\u0103 cu o prevalen\u0163\u0103 redus\u0103 (45% \u015fi, respectiv, 10%).<\/p>\n<p style=\"text-align: justify;\"><span style=\"text-decoration: underline;\">Anticorpii p-ANCA<\/span> apar tipic \u00een glomerulonefrita rapid progresiv\u0103 idiopatic\u0103, sindromul Churg-Strauss, poliangeita microscopic\u0103 \u015fi panarterita nodoas\u0103 clasic\u0103 (sensibilitate clinic\u0103 de 65%, 60%, 45% \u015fi respectiv 15%). Peste 90% din cazurile confirmate bioptic de glomerulonefrita necrotizant\u0103 pauciimun\u0103 sunt p-ANCA pozitive. p-ANCA se mai depisteaz\u0103 sporadic la unii pacien\u0163i cu o anumit\u0103 form\u0103 de sclerodermie, caracterizat\u0103 prin hemoragie pulmonar\u0103 \u015fi insuficien\u0163\u0103 renal\u0103 normotensiv\u0103<sup>3;5<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><span style=\"text-decoration: underline;\">Anticorpii x-ANCA<\/span> se asociaz\u0103 cu hepatitele autoimune, colangita sclerozant\u0103 primitiv\u0103, bolile inflamatorii intestinale (colita ulceroas\u0103 \u015fi boala Crohn), sindromul Felty<sup>1;5<\/sup>. Majoritatea pacien\u0163ilor adul\u0163i cu colit\u0103 ulceroas\u0103 prezint\u0103 anticorpi p-ANCA ce sunt sensibili la DNA-aza, proprietate ce poate ajuta \u00een diagnosticul diferen\u0163ial al anticorpilor p-ANCA din bolile inflamatorii de cei din hepatita autoimun\u0103 \u015fi colangita sclerozant\u0103.<\/p>\n<p style=\"text-align: justify;\">Ghidurile interna\u0163ionale (<em>International Consensus Statement<\/em>) recomand\u0103 testarea \u015fi raportarea ANCA utiliz\u00e2nd metoda imunofluorescen\u0163ei indirecte \u00een combina\u0163ie cu metoda imunoenzimatic\u0103 care detecteaz\u0103 specificita\u0163ile ANCA pentru MPO \u015fi PR3. Deseori, sub presiunea optimiz\u0103rii costurilor, screening-ul este realizat prin imunofluorescen\u0163\u0103 \u015fi este urmat de metoda imunoenzimatic\u0103 numai dac\u0103 rezultatul este pozitiv. O \u00eenalt\u0103 sensibilitate diagnostic\u0103 pentru anticorpii ANCA este dob\u00e2ndit\u0103 atunci c\u00e2nd se utilizeaz\u0103 simultan, din start, imunofluorescen\u0163a \u015fi metoda imunoenzimatic\u0103. Acest lucru poate fi posibil utiliz\u00e2nd o combina\u0163ie de neutrofile fixate cu etanol, neutrofile fixate cu formalin\u0103, substrat Hep-2, ficat de primate \u015fi spoturi tip microdrops cu amprente antigenice unice (MPO si PR3) \u00een acela\u015fi c\u00e2mp de incuba\u0163ie. Astfel este posibil\u0103 prediferen\u0163ierea autoanticorpilor prin compararea pattern-urilor fluorescente, iar acestea se pot confirma reciproc. Prin combinarea substraturilor conven\u0163ionale cu amprentele antigenice definite anti-MPO \u015fi anti-PR3, rezultatul testului de screening poate fi confirmat direct.<\/p>\n<p style=\"text-align: justify;\">Neutrofilele fixate cu etanol reprezint\u0103 substratul standard pentru anticorpii ANCA. Formalina previne migrarea antigenelor neutrofile din citoplasm\u0103 c\u0103tre membrana nuclear\u0103 \u015fi distruge antigenele nucleare. Pe substratul fixat cu etanol, antigenele neutrofile citoplasmatice sunt \u00eenc\u0103rcate pozitiv \u015fi migreaz\u0103 spre membrana nuclear\u0103 \u00eenc\u0103rcat\u0103 negativ, rezult\u00e2nd un pattern p-ANCA. Dac\u0103 neutrofilele sunt tratate cu formalin\u0103, se realizeaz\u0103 leg\u0103turi covalente \u00eentre proteine, migrarea este oprit\u0103 \u015fi antigenele\u00a0r\u0103m\u00e2n \u00een citoplasm\u0103. Astfel, probele av\u00e2nd un aspect p-ANCA pe substratul fixat cu etanol\u00a0 prezint\u0103 un aspect c-ANCA pe substratul fixat cu formalin\u0103, \u00een timp ce probele ANA pozitive devin negative sau \u00ee\u015fi reduc intensitatea c\u00e2nd sunt trecute pe substratul fixat cu formalin\u0103. Frecvent, probele pacien\u0163ilor sunt pozitive at\u00e2t pentru anticorpii ANCA, c\u00e2t \u015fi pentru\u00a0anticorpii ANA. Anticorpii ANA\u00a0 pot mima pattern-ul p-ANCA pe substratul fixat pe etanol, de aceea este necesar s\u0103 se fac\u0103 distinc\u0163ia \u00eentre pattern-urile c-ANCA \u015fi p-ANCA adevarate de cele non-ANCA (fals-pozitive)<sup>2<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Recomand\u0103ri pentru determinarea anticorpilor ANCA (condi\u0163ii clinice asociate)<\/em><\/strong><\/p>\n<div style=\"text-align: justify; padding-left: 30px;\">\u2022 glomerulonefrita (\u00een special forma rapid progresiv\u0103);<\/div>\n<div style=\"text-align: justify; padding-left: 30px;\">\u2022 hemoragie pulmonar\u0103;<\/div>\n<div style=\"text-align: justify; padding-left: 30px;\">\u2022 vasculita cutanat\u0103 cu manifest\u0103ri sistemice;<\/div>\n<div style=\"text-align: justify; padding-left: 30px;\">\u2022 noduli pulmonari multipli;<\/div>\n<div style=\"text-align: justify; padding-left: 30px;\">\u2022 afec\u0163iuni cronice distructive ale c\u0103ilor respiratorii superioare;<\/div>\n<div style=\"text-align: justify; padding-left: 30px;\">\u2022 sinuzita sau otita cu evolu\u0163ie \u00eendelungat\u0103;<\/div>\n<div style=\"text-align: justify; padding-left: 30px;\">\u2022 stenoza traheala subglotic\u0103;<\/div>\n<div style=\"text-align: justify; padding-left: 30px;\">\u2022 mononevrita multiplex sau alte neuropatii periferice;<\/div>\n<div style=\"text-align: justify; padding-left: 30px;\">\u2022 masa retroorbitar\u0103;<\/div>\n<div style=\"text-align: justify; padding-left: 30px;\">\u2022 boli inflamatorii de cauz\u0103 neprecizat\u0103<sup>5<\/sup>.<\/div>\n<p style=\"text-align: justify;\"><strong><em>Preg\u0103tire pacient <\/em><\/strong><em>- <\/em>\u00e0 jeun (pe nem\u00e2ncate) sau postprandial (dup\u0103 mese)<sup>2<\/sup>.<strong><em>\u00a0<\/em><\/strong><\/p>\n<p style=\"text-align: justify;\"><strong><em>Specimen recoltat <\/em><\/strong><em>- <\/em>\u0432\u0435\u043d\u043e\u0437\u043d\u0430\u044f \u043a\u0440\u043e\u0432\u044c<sup>2<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Recipient de recoltare <\/em><\/strong><em>- <\/em>vacutainer f\u0103r\u0103 anticoagulant cu\/f\u0103r\u0103 gel separator<sup>2<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Prelucrare necesar\u0103 dup\u0103 recoltare <\/em><\/strong><em>- <\/em>se separ\u0103 serul prin centrifugare<sup>2<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Volum prob\u0103<\/em><\/strong> \u2013 minim 2 mL ser<sup>2<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Cauze de respingere<\/em><\/strong> <strong><em>a probei <\/em><\/strong><em>- <\/em>ser intens hemolizat, lipemic sau puternic contaminat bacterian<sup>2<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Stabilitate prob\u0103 <\/em><\/strong><em>-<\/em><em>\u00a0serul separat este stabil 7 zile la 4\u00b0C; <em>timp mai \u00eendelungat<\/em> la -20\u00b0C<sup>3<\/sup>.<\/em><\/p>\n<p style=\"text-align: justify;\"><strong><em>Metod\u0103 <\/em><\/strong>- <span style=\"text-decoration: underline;\">imunofluorescen\u0163\u0103 indirect\u0103<\/span><sup>2<\/sup>.<\/p>\n<p style=\"text-align: justify;\"><strong><em>Valori de referin\u0163\u0103, comunicarea\u00a0\u015fi interpretarea rezultatelor<\/em><\/strong><\/p>\n<p style=\"text-align: justify;\">&lt;1\/10: Negativ<\/p>\n<div style=\"text-align: justify;\">\u00cen cazul unui rezultat pozitiv se va comunica titrul precum \u015fi aspectul c-ANCA, p-ANCA sau x-ANCA.<\/div>\n<div style=\"text-align: justify;\">Vor fi exclu\u015fi obligatoriu anticorpii ANA care mimeaz\u0103 p-ANCA. Aspectele c-ANCA \u015fi p-ANCA trebuie confirmate prin teste imunoenzimatice<sup>2<\/sup>.<\/div>\n<p style=\"text-align: justify;\"><strong><em>Limite \u015fi interferen\u0163e\u00a0<\/em><\/strong><\/p>\n<div style=\"text-align: justify;\">Testul ANCA nu trebuie utilizat ca test screening la persoane asimptomatice.<\/div>\n<div style=\"text-align: justify;\">Deciziile clinice nu trebuie s\u0103 se bazeze pe un singur rezultat ANCA pozitiv.<\/div>\n<div style=\"text-align: justify;\">\u00cen afara afec\u0163iunilor men\u0163ionate mai sus anticorpii ANCA mai pot fi \u00eent\u00e2lni\u0163i \u015fi \u00een alte condi\u0163ii clinice, cum ar fi: lupus eritematos sistemic, lupus eritematos indus medicamentos, sindrom Sj\u00f6gren, polimiozita \u015fi dermatomiozita, artrita reumatoid\u0103, artrita reactiv\u0103, sindrom antifosfolipidic, sindroame mielodisplazice, infectia HIV, endocardita bacterian\u0103 subacut\u0103, cromomicoza, ameobiaza invaziv\u0103, fibroza chistic\u0103, precum \u015fi \u00een anumite neoplazii<sup>4<\/sup>.<\/div>\n<p style=\"text-align: justify;\"><span style=\"font-size: small;\">\u00a0<\/span><\/p>\n<p style=\"text-align: justify;\"><strong><span style=\"font-size: 10pt;\">\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/strong><\/p>\n<div style=\"text-align: justify;\"><span style=\"font-size: small;\">1. <span style=\"font-size: 10pt;\">A. R. Bradwell, R.P. Stokes, G. D. Johnson. Atlas of Autoantibody Patterns on Tissues, 1997, 95-97.<\/span><\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">2. Laborator Synevo. Referin\u0163ele specifice tehnologiei de lucru utilizate 2010. Ref Type: Catalog<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">3. Laboratory Corporation of America.Directory of Services and Interpretive Guide. Antineutrophil Cytoplasmic Antibodies (ANCA). www.labcorp.com 2010. Ref Type: Internet Communication.<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">4. Rex M. McCallum, David J. Bylund. Vasculitis. In In Henry\u00b4S.Clinical Diagnosis and Management By Laboratory Methods, Ed.Saunders, 2007, 933-943.<\/span><\/div>\n<div style=\"text-align: justify;\"><span style=\"font-size: 10pt;\">5. Werner J. Mayet. Autoantibodies in Systemic Vasculitis. In Clinical Laboratory Diagnostics-Use and Assessment of Clinical Laboratory Results. Lothar Thomas. TH-Books Verlagsgesellschaft mbH, Frankfurt \/Main, Germany,1 ed. 1998, 842-845.<\/span><\/div>","protected":false},"excerpt":{"rendered":"<p>\u0422\u0435\u0441\u0442, \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u0443\u044e\u0449\u0438\u0439\u0441\u044f \u0432 \u0434\u0438\u0430\u0433\u043d\u043e\u0441\u0442\u0438\u043a\u0435 \u0441\u0438\u0441\u0442\u0435\u043c\u043d\u044b\u0445 \u0432\u0430\u0441\u043a\u0443\u043b\u0438\u0442\u043e\u0432. \u041f\u0440\u0438 \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0438 \u0441\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0438 \u043c\u0435\u0442\u043e\u0434\u043e\u043c \u043d\u0435\u043f\u0440\u044f\u043c\u043e\u0439 \u0438\u043c\u043c\u0443\u043d\u043e\u0444\u043b\u044e\u043e\u0440\u0435\u0441\u0446\u0435\u043d\u0446\u0438\u0438 \u0441 \u0438\u0441\u043f\u043e\u043b\u044c\u0437\u043e\u0432\u0430\u043d\u0438\u0435\u043c \u0444\u0438\u043a\u0441\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u044b\u0445 \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u043e\u0432 \u043d\u0435\u0439\u0442\u0440\u043e\u0444\u0438\u043b\u043e\u0432 \u0447\u0435\u043b\u043e\u0432\u0435\u043a\u0430 \u043d\u0430\u043b\u0438\u0447\u0438\u0435 \u0430\u043d\u0442\u0438\u0442\u0435\u043b \u0442\u0430\u043a\u043e\u0433\u043e \u0442\u0438\u043f\u0430 \u043f\u0440\u043e\u044f\u0432\u043b\u044f\u0435\u0442\u0441\u044f \u0432 \u0432\u0438\u0434\u0435 \u0434\u0438\u0444\u0444\u0443\u0437\u043d\u043e\u0433\u043e \u0446\u0438\u0442\u043e\u043f\u043b\u0430\u0437\u043c\u0430\u0442\u0438\u0447\u0435\u0441\u043a\u043e\u0433\u043e (cANCA) \u0438\u043b\u0438 \u043f\u0435\u0440\u0438\u043d\u0443\u043a\u043b\u0435\u0430\u0440\u043d\u043e\u0433\u043e (pANCA) \u043e\u043a\u0440\u0430\u0448\u0438\u0432\u0430\u043d\u0438\u044f. \u041e\u043d\u0438 \u0441\u0432\u044f\u0437\u044b\u0432\u0430\u044e\u0442\u0441\u044f \u0441 \u043a\u043e\u043c\u043f\u043e\u043d\u0435\u043d\u0442\u0430\u043c\u0438 \u0446\u0438\u0442\u043e\u043f\u043b\u0430\u0437\u043c\u0430\u0442\u0438\u0447\u0435\u0441\u043a\u0438\u0445 \u0433\u0440\u0430\u043d\u0443\u043b \u043d\u0435\u0439\u0442\u0440\u043e\u0444\u0438\u043b\u043e\u0432 \u0438 \u043c\u043e\u043d\u043e\u0446\u0438\u0442\u043e\u0432.<\/p>\n<p>\u041a\u0430\u043a \u043f\u043e\u043a\u0430\u0437\u0430\u043d\u043e, \u043e\u0441\u043d\u043e\u0432\u043d\u043e\u0439 \u0430\u043d\u0442\u0438\u0433\u0435\u043d\u043d\u043e\u0439 \u043c\u0438\u0448\u0435\u043d\u044c\u044e \u0434\u043b\u044f cANCA \u044f\u0432\u043b\u044f\u0435\u0442\u0441\u044f \u043b\u0438\u0437\u043e\u0441\u043e\u043c\u0430\u043b\u044c\u043d\u0430\u044f \u043f\u0440\u043e\u0442\u0435\u0438\u043d\u0430\u0437\u0430 (PR-3), \u0434\u043b\u044f pANCA &#8211; \u043c\u0438\u0435\u043b\u043e\u043f\u0435\u0440\u043e\u043a\u0441\u0438\u0434\u0430\u0437\u0430 (MPO). \u041f\u043e \u0442\u0438\u043f\u0443 \u0441\u0432\u0435\u0447\u0435\u043d\u0438\u044f pANCA \u043c\u043e\u0433\u0443\u0442 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\u0441\u0438\u043d\u0443\u0441\u0438\u0442\u0430\u043c\u0438 \u0438 \u0433\u0435\u043c\u0430\u0442\u0443\u0440\u0438\u0435\u0439). \u0418\u0445 \u043c\u043e\u0436\u043d\u043e \u043d\u0430\u0431\u043b\u044e\u0434\u0430\u0442\u044c \u043f\u0440\u0438 \u0434\u0440\u0443\u0433\u0438\u0445 \u0444\u043e\u0440\u043c\u0430\u0445 \u0432\u0430\u0441\u043a\u0443\u043b\u0438\u0442\u043e\u0432 \u2013 \u0443\u0437\u0435\u043b\u043a\u043e\u0432\u043e\u043c \u043f\u0435\u0440\u0438\u0430\u0440\u0442\u0435\u0440\u0438\u0438\u0442\u0435, \u0441\u0438\u043d\u0434\u0440\u043e\u043c\u0435 \u0427\u0430\u0440\u0433\u0430\u2013\u0421\u0442\u0440\u043e\u0441\u0441\u0430 (Churg-Strauss, \u044d\u043e\u0437\u0438\u043d\u043e\u0444\u0438\u043b\u044c\u043d\u044b\u0439 \u0433\u0440\u0430\u043d\u0443\u043b\u0435\u043c\u0430\u0442\u043e\u0437\u043d\u044b\u0439 \u0430\u043d\u0433\u0438\u0438\u0442, \u0432\u0430\u0441\u043a\u0443\u043b\u0438\u0442 \u0441\u0440\u0435\u0434\u043d\u0438\u0445 \u0441\u043e\u0441\u0443\u0434\u043e\u0432), \u00abpauchi-immune\u00bb \u043d\u0435\u043a\u0440\u043e\u0442\u0438\u0437\u0438\u0440\u0443\u044e\u0449\u0435\u043c \u0431\u044b\u0441\u0442\u0440\u043e\u043f\u0440\u043e\u0433\u0440\u0435\u0441\u0441\u0438\u0440\u0443\u044e\u0449\u0435\u043c \u0433\u043b\u043e\u043c\u0435\u0440\u0443\u043b\u043e\u043d\u0435\u0444\u0440\u0438\u0442\u0435 (\u0441\u043c. \u0442\u0430\u043a\u0436\u0435 \u0442\u0435\u0441\u0442 \u2116 807 \u2013 \u0430\u043d\u0442\u0438\u0442\u0435\u043b\u0430 \u043a \u0431\u0430\u0437\u0430\u043b\u044c\u043d\u043e\u0439 \u043c\u0435\u043c\u0431\u0440\u0430\u043d\u0435 \u043a\u043b\u0435\u0442\u043e\u043a \u043f\u043e\u0447\u0435\u043a). \u041f\u0430\u0442\u043e\u0433\u0435\u043d\u0435\u0437 \u044d\u0442\u0438\u0445 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f \u0438 \u0440\u043e\u043b\u044c \u0430\u0443\u0442\u043e\u0438\u043c\u043c\u0443\u043d\u043d\u044b\u0445 \u0430\u043d\u0442\u0438\u0442\u0435\u043b \u0432 \u043d\u0451\u043c \u043d\u0435\u044f\u0441\u043d\u044b. \u041f\u0440\u0435\u0434\u043f\u043e\u043b\u0430\u0433\u0430\u0435\u0442\u0441\u044f \u0432\u043e\u0432\u043b\u0435\u0447\u0435\u043d\u0438\u0435 ANCA \u0432 \u0430\u043a\u0442\u0438\u0432\u0430\u0446\u0438\u044e \u043d\u0435\u0439\u0442\u0440\u043e\u0444\u0438\u043b\u043e\u0432 \u0438 \u043f\u043e\u0432\u0440\u0435\u0436\u0434\u0435\u043d\u0438\u0435 \u044d\u043d\u0434\u043e\u0442\u0435\u043b\u0438\u044f, \u043f\u0440\u0438\u0432\u043e\u0434\u044f\u0449\u0435\u0435 \u043a \u043f\u0440\u043e\u0434\u0443\u043a\u0446\u0438\u0438 \u043f\u0440\u043e\u0432\u043e\u0441\u043f\u0430\u043b\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u0445 \u0446\u0438\u0442\u043e\u043a\u0438\u043d\u043e\u0432 \u0438 \u0441\u0442\u0438\u043c\u0443\u043b\u044f\u0446\u0438\u0438 \u0438\u043c\u043c\u0443\u043d\u043e\u043f\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u0447\u0435\u0441\u043a\u043e\u0433\u043e \u043f\u0440\u043e\u0446\u0435\u0441\u0441\u0430. 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