评价自身抗体联合检测在诊断自身免疫性疾病中的应用

目的探讨检测抗核抗体（ANA）核型与抗可提取性核抗原（ENA）抗体及抗双链DNA（ds，DNA）抗体之间的相关性，提高对自身免疫性疾病（AID）的诊断及鉴别诊断参考价值。方法资料来源门诊及住院的AID病例血清标本进行检测，ANA检测采用问接免疫荧光法（IIF），抗ENA抗体检测采用欧蒙斑点法（抗nRNP／SIn、Sm、SSA／Ro、SSB／Lo、Scl-70和Jo—1）六项抗体及抗（ds—DNA）抗体采用ELISA法检测。结果在98例ANA阳性病例血清标本中核型分布为：细胞核均质型（36．74％），细胞核颗粒型（41．84％），细胞核仁型（11．22％），细胞核膜型（1．02％），细胞核着丝点型（1．02％）；重叠核型中细胞核均质型／细胞核颗粒型（2．04％），细胞核均质型／细胞浆颗粒型（6．12％）等。98例ANA与ENA同时阳性血清标本中42例抗双链DNA抗体阳性（42．86％）。36例均质型阳性样本中抗SSA／Ro抗体（24．48％），抗SSB／Lo抗体（6．12％），抗nRNP／Sm抗体（6．12％）。41例细胞核颗粒型阳性样本抗nRNP／Sm抗体（19．39％），SSAfRo抗体（15．31％），抗SSB／Lo抗体（6．12％）。ANA阳性可出现一种或多种自身抗体。结论ANA常见核型有：细胞核颗粒型，细胞核均质型及细胞核仁型。ANA均质型核型检出的抗ds-DNA抗体为主，且抗ds—DNA抗体含量与荧光强度成正比。ANA核型与抗ENA抗体二者之间有一定的相对应性。ANA及核型、抗ENA抗体和抗ds—DNA抗体的联合检测可明确诊断AID，而且利于判断患者血清中各种自身抗体与临床表现的关系。

Association among ANA Patterns,Anti-ENA Antibody and Anti-dsDNA Antibody in Autoimmune Disease

Objective To investigate the association among ANA patterns, anti-ENA antibody and anti-dsDNA antibodies in autoimmune diseases, and the reference significance of detecting these antibodies on the diagnosis and differential diagnosis of autoimmune diseases. Methods Serum samples from 98 pateints with autoimmune disorder were collected. ANA, anti-ENA and anti-dsDNA antibodies were detected using IIF, immuno-dot assay and ELISA. Results The distribution of different ANA nuclear types in the 98 samples was： pattern homogeneous （36.74%）; pattern nucleoplasm granular （41.84%）; pattern nucleolar （11.22%）; pattern nuclear membrane （1.02%）; pattern centromere （1.02%）; pattern homogeneous/nucleoplasm granular （2.04%）and pattern homogeneous/cytoplasm granular （6.12%）. These patterns may occur separately, also could appear at the same sample. Among these 98 samples with both ANA and anti-ENA positive, 42 cases were anti-dsDNA antibodies positive （42.86%）. In the 36 patients with ANA-homogeneous, 24 cases were anti-SSA /Ro antibody positive, 6 cases were anti-SSB/La antibody positive, and 6 cases were nRNP/Sm antibody positive. While in the 41 ANA-nucleoplasm granular samples, the positive rates of SSARo, SSB/La and nRNP/Sm antibodies were 15.31%, 6.12% and 19.39%. One or several kinds of ENA antibodies could appear in patients with positive ANA and anti-dsDNA antibodies. Conclusion The familiar nuclear types of ANA include pattern nucleoplasm granular, pattern homogeneous and pattern nucleolar. They occur individually or concurrently, which was correlated with the appearance of anti-ENA and anti- dsDNA antibodies. Combined detection ofANA, ENA and dsDNA antibodies has higher specificity, sensibility and accuracy in the diagnosis of autoimmune diseases, and is better in describing the correlation of the auto-antibodies appeared in patients and his clinical manifestation, thus provide valuable reference index to the diagnosis, differential diagnosis and therapy of AID.