间接免疫荧光法筛查抗核抗体与特异性抗体检测的相互关系

摘要

目的:分析以间接免疫荧光法(indirect immunofluorescence,IIF)筛查的大样本抗核抗体(antinuclear antibody,ANA)结果与特异性抗体检测结果的相互关系,以确定其临床意义及临床实践中二者是否能够相互代替.方法:采用IIF筛查2026份临床连续送检血清标本的ANA,采用线性免疫印迹法(line immunoassay,LIA)检测ANAs特异性抗体,将2026份标本分为自身免疫性疾病(autoimmune diseases,AID)组、疑似AID组、非AID组,分析检测结果的相互关系和临床意义.结果:2026份标本中,IIF阳性LIA阳性882份,占43.53%;IIF阳性/LIA阴性266份,占13.13%;IIF阴性/LIA阴性507份.占25.02%,IIF阴性/LIA阳性206份,占10.17%.IIF与LIA检测ANA的结果总体符合率为68.56%(K=0.472,P<0.01),2种方法检测结果的差异有统计学意义(X2=416.21,P<0.01).IIF阴性/LIA非阴性组中,抗Ro-52、抗干燥综合征抗原A(SS-A)、抗双链DNA(dsDNA)、抗线粒体抗体M2亚型(AMA-M2)、抗史密斯抗原(Sm)、抗干燥综合征抗原B(SS-B)、抗核糖核蛋白/史密斯抗原(nRNP/Sm)和抗组氨酰tRNA合成酶抗原(Jo-1)抗体的阳性率分别为6.00%-34.94%;IIF阴性/LIA非阴性的312例患者中,AID患者116例,占37.18%,高于非AID患者(22.11%),且差异有统计学意义(X2=16.97,P<0.01).IIF 阳性/LIA非阳性的325例患者中,AID患者156例,占48.00%,高于非AID患者(22.15%),而且AID患者在IIF-ANA滴度1:80、1:160-1:320和≥1:640各组中的比例均高于非AID患者,其差异有统计学意义(X2=26.96、X2=7.89、X2=19.42,P<0.01).结论:IIF筛查ANA容易导致AID患者部分具有重要临床意义的ANA特异性抗体漏检,而ANA特异性抗体检测因其测定的抗体数量有限也容易导致AID患者的ANA漏检.IIF-ANA筛查和LIA-ANAs特异性抗体检测不能相互代替,对需要通过检测ANA来排除AID的患者标本应同时进行IIF-ANA筛查和ANAs特异性抗体的检测,以避免仅采用1种方法进行检测时导致的AID患者漏诊.%Objective To analyze the correlation between the antin-uclear antibody (ANA) results of large samples by indirect immunofluorescence (IIF) screening and specific anti-nuclear antibodies test and study the clinical significance of them and clarify whether they could replace each other in clinical practice.Methods 2 026 cases of consecutive clinical samples for ANA testing were tested by IIP with Hep-2 and line immunoassay (LIA) for the detection of specific ANA antibodies. All the samples were divided into autoimmune diseases ( AID) group, suspected AID group and non-AID group. The relationship between different test results and their clinical significance were analyzed. Results Of the 2 026 cases of specimens, 882 cases (43.53%) were IIF-ANAVLIA-ANAs+ , 266 cases (13. 13%) were IIF-ANAV LIA-ANAs ~ , 507 cases (25.02%) were IIF-ANA" /LIA-ANAs" and 206 cases (10. 17%) were IIF-ANA ~ /LIA-ANAs+. The overall compliance rate of IIF-ANA and LIA-ANA was 68. 56% , the consistency rate was moderate (K=0. All, P <0. 01), and there was significant difference between the results of IIF-ANA and UA-ANA {x2 = 416.21, P < 0.01). The positive rates of anti-Ro-52, anti-SS-A (Sjogren' s syndrome antigen A) , anti-dsDNA (double-stranded DNA) , anti-AMA-M2 (Anti-mitochondrial antibody M2) , anti-Sm (Smith antigen), anti-SS-B (Sjogren's syndrome antigen B), anti-nRNP/Sm (nuclear ribonucleoprotein/Smith antigen) and anti-Jo-1 (Jo-1 antigen) antibodies ranged from 6. 00% to 34.94% in the IIF-ANA"/LIA-ANAs+/1 group. Of the 312 cases of this group, 37. 18% patients (116 cases) were diagnosed as AID, higher than the non-AID group (22. 11 % ) (x2 = 16.97, P < 0. 01). Of the 325 cases of IIF-ANA+ /LIA-ANAs '' * group, 48. 0% of patients (156 cases ) were diagnosed as AID, higher than the non-AID group (22. 15% ) , and the proportion of patients with AID was higher than non-AID in each group of patients with IIF-ANA liter 1:80, 1:160-1 =320 and 2* 1:640 (x2 = 26.96, 7. 89, 19. 42, P < 0.01). Conclusions It has a tendency to miss some ANAs specific antibodies which has important clinical significance when ANA was screened only by IIF, whereas the detection of ANA specific antibodies is very limited, it is also very easy to lead to false negative in patients with autoimmune diseases. The screening of ANA by IIF and the detection of ANA specific antibodies by LIA could not replace each other in clinical practice. In order to avoid misdiagnosis of patients with autoimmune diseases, it is recommend to screen ANA by IIF and detect ANA specific antibodies simultaneously when the ANA test is needed to excluded the presence of autoimmune diseases.