抗核抗体与抗核抗体谱联合检测在自身免疫性疾病诊断上的应用

目的探讨抗核抗体(antinuclear antibody,ANA)和抗核抗体谱(antinuclear antibodies spectrum,ANAs)联合检测在自身免疫性疾病(autoimmune diseases,AID)诊断上的应用方案及价值,从而降低现症及潜在AID患者的漏检率。方法对1 231份本院门诊和住院疑似AID患者的血清标本分别采用间接免疫荧光法(indirect immunofluorescence,IIF)和免疫印迹法(immumoblottest,IBT)检测ANA和ANAs,对其中IIF-ANA1∶100(-)/IBT-ANAs(+)标本分别进行1∶10及1∶32稀释后采用IIF检测ANA,最后对上述检测结果进行统计分析。结果 1 231份血清标本中ANA阳性414份,占33.63%,ANAs阳性429份,占34.85%。按不同检测方案进行分组,发现同时检测IIF-ANA与IBT-ANAs的方案对确诊/疑似AID病人检出率最高(43.05%),分别与应用IIF-ANA进行AID的初筛的方案、仅检测IBT-ANAs的方案相比均有统计学意义(χ2=23.12,P<0.05,χ2=17.42,P<0.05)。对116份(9.42%)IIF-ANA 1∶100(-)/IBT-ANAs(+)的标本分别进行1∶32及1∶10稀释后再采用IIF检测ANA,发现其中103份标本ANA荧光结果≥1∶32,10份标本ANA荧光结果<1∶32而≥1∶10,3份标本ANA荧光结果<1∶10;将标本增加1∶32和1∶10稀释度可将AID确诊/疑似病例检出率分别提高8.37%(χ2=20.84,P<0.05)与9.18%(χ2=24.70,P<0.05),但二者之间相比则无统计学意义(χ2=0.17,P>0.5)。结论 IIF-ANA可应用于大范围AID病人初筛以减轻病人经济负担及实验室工作量压力。但是仅检测IIF-ANA或IBT-ANAs均可导致临床上患有AID或潜在的AID病人的漏检。联合检测IIF-ANA和IBT-ANAs,尤其是对临床高度怀疑AID、且ANA荧光结果≥1:32的标本进行IBT-ANAs的检测可显著提高检出率,从而降低现症及潜在AID患者的漏检率。

Amplification of the combinational detection of antinuclear antibody and antinuclear antibodies spectrum in the diagnosis of autoimmune diseases

Autoantibody is an important diagnostic index of autoimmune diseases(AID).In order to investigate the diagnostic value of antinuclear antibody(ANA) and antinuclear antibodies spectrum(ANAs) in patients with AID,from October 2011 to December 2011,1 231 presumptive AID patients were chosen for research by the Xiamen Center of Clinical Laboratory.ANA and ANAs were detected with indirect immunofluorescence(IIF) and immumoblot test(IBT) respectively,while the initial dilution of IIF-ANA was 1:100.In this study,three testing programs were performed:the IIF-ANA,the IBT-ANAs,the combination of ANA and ANAs.The positive rates of IIF-ANA and IBT-ANAs were 33.63% and 34.85%,respectively.The positive rate of ANA and ANAs in combination was 43.05%,which was higher than IIF-ANA or IBT-ANAs along(P<0.05).There were 116 patients(9.42%) with IIF-ANA 1:100(-)/IBT-ANAs(+),which were detected by IIF-ANA at the dilution of 1:32 and 1:10,and results showed that 103 patients were positive for IIF-ANA by 1:32 dilution,10 patients were positive by 1:10 dilution,and 3 patients were with negative by 1:10 dilution.The positive rates of IIF-ANA(1:32) and IIF-ANA(1:10) were 8.37% and 9.18%,respectively,which were higher than IIF-ANA(1:100)(P<0.05),but there was not statistically significant(χ2=0.17,P>0.5) between IIF-ANA(1:32) and IIF-ANA(1:10).We conclude that IIF-ANA can be used in the screening of AID.While simply testing of ANA or ANAs would lead to missed diagnosis of AID,combinational detection of ANA and ANAs will reduce the false negative rate,especially for those suspected cases with positive ANA by 1:32 dilution.