抗核抗体与特异性自身抗体检测结果不一致的临床意义分析

目的比较间接免疫荧光法（IIF）筛查抗核抗体（ANA）与线性免疫印迹法（LIA）检测抗核抗体谱（ANAs）特异性抗体结果不一致性,分析二者的相互关系及临床意义。方法采用IIF筛查ANA和LIA检测ANAs特异性抗体,将IIF-ANA阳性/LIA-ANAs阴性和IIF-ANA阴性/LIA-ANAs阳性患者分为自身免疫性疾病（AID）组和非AID组进行比较分析。结果 216例IIF-ANA阴性AID组中,LIA-ANAs阳性率为46.30%,高于非AID组（20.00%,P=0.00）;AID组LIA-ANAs（＋）、LIA-ANAs（±）的比率均高于非AID组（P〈0.05）。IIF-ANA阴性、LIA-ANAs阳性中,抗Ro-52、抗SSA、抗双链DNA（dsDNA）、抗线粒体抗体M2亚型（AMA-M2）、抗Sm、抗SSB、抗核糖核蛋白（nRNP-Sm）和抗组氨酰tRNA合成酶抗体（Jo-1）为主要阳性自身抗体;AID组及非AID组IIF-ANA阳性者荧光滴度分布均以1∶80～1∶160为主,2组的阳性率差异无统计学意义（P〉0.05）;而荧光滴度为≥1∶1 280时,2组间的差异有统计学意义（P〈0.05）;AID组中IIF（＋）、LIA（-）的荧光模式以细胞核均质型（H）为主,与非AID组比较,差异有统计学意义（P〈0.01）;而非AID组的荧光模式以细胞核斑点型（S）为主,与AID组比较,差异无统计学意义（P〉0.05）。结论在AID的临床诊断中,除进行IIF筛查ANA外,还需根据具体情况进行特异性自身抗体的检测,避免单一方法检测导致AID患者的漏诊。

The clinical significance on the inconsistent results of antinuclear antibody and specific auto antibody determinations

Objective To compare the inconsistent results of the indirect immunofluorescence（IIF） assay screening for antinuclear antibody（ANA） and linear immunoblot assay（LIA） for antinuclear antibody spectrum（ANAs） specific antibody,and evaluate the relationship and clinical significance.Methods The samples were determined for ANA screening by IIF and for ANAs by LIA.The patients with the results of IIF-ANA＋ and LIA-ANAs-and IIF-ANA-and LIA-ANAs＋ were classified into autoimmune disease（AID） group and non-AID group.Results In the 216 cases with IIF-ANA-of AID group,The LIA-ANAs＋ rate was 46.30%,and the positive rate was higher than that of non-AID group（20.00%,P=0.00）.The ratios of LIA-ANAs（＋） and LIA-ANAs（±） of AID group were higher than those of non-AID group（P0.05）.In IIF-ANA-and LIA-ANAs＋ group,the main positive autoantibodies included anti-Ro-52,anti-SSA,anti-double-stranded DNA（dsDNA）,anti-mitochondrial antibody M2 subtype（AMA-M2）,anti-Sm,anti-SSB,anti-nuclear ribonucleoprotein（nRNP-Sm） and anti-histidyl-tRNA synthetase antibodies（anti-Jo-1）.In the cases of AID group and non-AID group,the fluorescence titers of IIF-ANA＋ were 1∶ 80-1∶ 160,which was no significant difference between the AID and non-AID groups（P0.05）.However,when the fluorescence titer was ≥1∶ 1 280,the difference between 2 groups was statistically significant（P0.05）.In the AID group,the main fluorescence mode of IIF（＋） and LIA（-） was homogeneous pattern（H）,and the difference was statistically significant compared with non-AID group（P0.01）.The main fluorescence mode of non-AID group was nuclear spot pattern（S）,and the difference was not statistically significant compared with AID group（P0.05）.Conclusions In the diagnosis of AID,besides the screening determination by IIF,it is necessary to detect the specific auto antibodies in AID patients in order to avoid the missed detection of AID.