抗核抗体谱的检测在自身免疫性疾病中的应用价值

Application value of antinuclear antibody spectrum detection in diagnosis of autoimmune diseases

目的探讨用间接免疫荧光法(IIF)抗核抗体(ANA)与免疫印迹法(LIA)特异性抗核抗体谱(ANAs)的联合检测在自身免疫性疾病(AID)中的应用价值。方法 436例患者,其中自身免疫病患者271例,非自身免疫病患者165例,所有患者同时检测血清ANA和ANAs,两种检测方法产生4种检出模式:IIF(+)/LIA(+)、IIF(-)/LIA(-)、IIF(+)/LIA(-)和IIF(-)/LIA(+)。结果 436份标本中IIF(+)/LIA(+)占40.15%,IIF(-)/LIA(-)占25.52%,IIF(+)/LIA(-)占15.27%,IIF(-)/LIA(+)占9.81%,IIF与LIA检测ANA的结果总体符合率为65.67%,ANA和ANAs在自身免疫病患者中的阳性率分别是65.3%和57.9%,显著高于非自身免疫病患者的17.6%和20.0%;ANA和ANAs在自身免疫病组和非自身免疫病组间阳性率比较,差异有统计学意义(P<0.01)。两检测结果仅在MCTD和SLE患者中存在相关性(P<0.01),在其他观察组中不存在相关性(P>0.05)。结论 IIF检测ANA容易导致AID患者部分具有临床意义的ANA特异性抗体漏检,而ANAs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和LIA-ANAs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和LIF-ANAs的检测,以避免仅采用一种方法进行检测时导致AID患者漏诊。ANA的IIF法易导致以抗-SSA、抗-SSB和抗-Ro52为主要抗体的患者ANA假阴性,而LIA法特异性ANAs的检测因检测的抗体不全面也无法取代ANA的IIF法检测。在临床实际工作中两种ANA的检测方法不能相互取代,应联合应用。

Objective To investigate the application value of the combination detection of the serum antinucle- ar antibody（ANA） measured by the indirect immunofluorescence（IIF） and the antinuclear antibodies（ANAs） meas- ured by Western blot（LIA） in diagnosing autoimmunity diseases（AID）. Methods 436 patients were selected,inclu- ding 271 patients with autoimmune diseases and 165 patients with non-autoimmune diseases. Serum ANA and ANAs were measured in all patients at the same time. The two detection methods produced four kinds of results：IIF（＋）/ LIA（＋） ,IIF（-）/ LIA（-） ,IIF（＋）/ LIA（-） and IIF（-）/ LIA（＋）. Results Among 436 specimens,the results of IIF（＋）/ LIA（＋） accounted for 40.15%,IIF（-）/LIA（-） for 25.52%,IIF（＋）/LIA（-） for 15.27%,and IIF （-）/ LIA（＋） for 9.81%. The coincidence rate of IIF and LIA results detecting ANA was 65.67%. The positive rates of ANA and ANAs in the patients with autoimmune diseases were 65.3% and 57.9%, obviously higher than 17.6% and 20.0% in the patients with non-autoimmune diseases. The difference in positive rates of ANA and ANAs between the autoimmune disease group and the non-selbimmune disease group had statistical significance（P〈0.01）. The correlation of the results of two detection methods only existed in MCTD and SLE patients（P〈0.01）, but with- out correlation among the other observation groups（P〉0.05）. Conclusion IIF detecting ANA will easily miss some AID patients with positive ANA-specific antibodies,while ANAs detection will also easily lead to ANA of AID pa- tients missed because of its limitation in detecting the number of antibody. So the IIF-ANA and LIA-ANAs detection can not substitute each other. The patient specimens which need to exclude AID by detecting ANA should use the IIF-ANA and LIF-ANAs detection at the same time, to avoid AID patients tmissed diagnosis when only one method is used to detect. The IIF method of ANA will easily lead to ANA false-negative in the patients with the primary anti- bodies of anti-SSA,anti-SSB and anti-Ro52. Due to the incomplete detection of antibodies, the specific ANAs detec- tion of LIA method can not replace the IIF method. The two ANA detection methods can not replace each other,but should be combined in clinical practice work.