抗核抗体荧光模型与抗核抗体谱对应关系研究

Analysis of the Relationship between Fluorescence Patterns of Antinuclear Antibody and Antinuclear Antibody Profiles

目的探讨间接免疫荧光法检测抗核抗体(ANA)荧光模型与ANA谱(包括抗ds DNA、抗RNP、抗Sm、抗SSa、抗SSb、抗Scl-70、抗Jo-1和抗rib-P)检测结果的对应关系。方法回顾性分析2010年1月-2013年12月间7 385例ANA荧光模型与ANA谱中8种特异性自身抗体之间的对应关系。ANA采用以人喉表皮样癌细胞为底物的间接免疫荧光法(IIF法)检测;ANA谱中的抗ds DNA采用以绿绳短膜虫为底物的IIF法检测,其他7种抗体采用纯化抗原的免疫条带法检测。结果 ANA荧光模型为颗粒型主要见于抗RNP、抗Sm、抗SSa及抗SSb(P<0.001);均质型主要见于抗ds DNA及抗SSa(P<0.001);核仁型、着丝点型、复合荧光模型主要见于抗SSa(P<0.05);胞浆型主要见于抗rib-P和抗SSa(P<0.05);而高尔基体型、核点型、周边型、肌动蛋白型、原肌球蛋白型、增殖细胞核抗原(PCNA)型、波形蛋白型荧光模型时8种自身抗体的检出率均较低甚至无法检出。当单纯抗ds DNA阳性时荧光模型为均质型出现频率高达77.91%(P<0.001);单纯抗RNP或抗SSa或抗Sm时为颗粒型出现频率分别为96.84%、52.01%和82.35%(P<0.001);单纯抗Scl-70阳性时均质型与核仁型2种复合荧光模型的出现频率达30.53%(P<0.001);抗rib-P和抗Jo-1阳性时胞浆型的出现频率分别为50.00%和61.54%(P<0.05),但单纯抗SSb阳性时并未发现优势荧光模型。结论 ANA荧光模型与ANA谱之间具有一定的规律。颗粒型、均质型、胞浆型荧光模型可对应多种自身抗体;而着丝点型、高尔基体型、核点型、周边型、肌动蛋白型、原肌球蛋白型、PCNA型、波形蛋白型8种临床常规检测的自身抗体的检出率均很低;抗ds DNA主要对应ANA均质型,抗RNP、抗SSa及抗Sm主要对应颗粒型,抗Scl-70主要对应均质核仁复合型,抗rib-P和抗Jo-1主要对应胞浆型,该结果可为临床医生检验项目申请及实验室结果核对提供依据。

Objective To discuss the relationship between antinuclear antibody （ANA） fluorescence pattern detected by indirect immunity fluorescence （IIF） and antinuclear antibody profiles （including anti-dsDNA, RNP, Sm, SSa, SSb, Scl-70, Jo-1 and rib-P） in human serum. Methods A total of 7385 cases of ANA pattern and ANA profiles were retrospectively analyzed from January 2010 to December 2013. ANA was detected by IIF substrated as HEp-2 cells, anti- dsDNA by IIF substrated as crithidia, and the other 7 antibodies by enzyme immunoblot with purified antigen. Results Granular pattern mostly presented as anti-RNP, anti-Sin, anti-SSa and anti-SSb （P 〈 0.001）; homogeneous pattern was anti-dsDNA and anti-SSa （P 〈 0.001）; nudeolus, centromere, and mixed pattern was anti-SSa （P 〈 0.05）; cytoplasm pattern was anti-rib-P and anti-SSa （P 〈 0.05）. But few above antibodies could be detected in Golgi, dots, rim, actin,actotropomyosin, prolifevating cell nuclear antigen （PCNA） and vementin pattern. Homogeneous pattern was shown up to 77.91% in only anti-dsDNA positive serum; granular was 96.84%, 52.01%, and 82.35% respectively in only anti- RNP or anti-SSa or anti-Sm positive. Homogeneous and nucleolus mix pattern was up to 30.53% in only anti-Scl-70 positive. Cytoplasm pattern was 50.00% and 61.54% respectively in only anti-rib-P or anti-Jo-1 positive. But no fixed relationship was found between ANA pattern and anti-SSb. Conclusions There is a certain relationship between ANA and antinuclear antibody profiles. Granular, homogeneous and cytoplasm pattern often can be detected more than one autoantibodies. Eight kinds of specific autoantibodies often are negative when ANA patterns are centromere, Golgi, dots, rim, actin, tropomyosin, PCNA, and vimentin. Anti-dsDNA is mainly corresponding to homogeneous, anti-RNP, anti- SSa and anti-Sm to granular, anti-Scl-70 to homogeneous and nudeoli, anti- rib-P and anti-Jo-1 to cytoplasm. The study can give suggestions for further tests application and lab result checking.