抗核抗体联合抗核抗体谱诊断自身免疫性疾病的临床准确率

Clinical accuracy of antinuclear antibody combined with antinuclear antibody spectrum in diagnosis of autoimmune diseases

目的探讨抗核抗体(ANA)联合抗核抗体谱(ANAs)诊断自身免疫性疾病(AID)的临床准确性。方法选择2016年6月至2018年6月本院收治的145例AID患者(AID组)和100例非AID患者(对照组)为研究对象,采用酶联免疫吸附法检测血清ANA水平,采用免疫印迹法检测血清中抗nRNP、Sm、SS-A(天然SS-A和Ro-52)、SS-B、Scl-70、PM-Scl、Jo-1、CENPB、PCNA、dsDNA、核小体、组蛋白、核糖体P蛋白和AMA-M2共14种特异性抗体水平。结果对照组未检出ANA阳性,AID组中共检出97例阳性,阳性检出率为66.90%,SLE患者中ANA阳性检出率最高,为90.48%。AID组患者的ANA阳性检出率和各疾病亚组患者的ANA阳性检出率均显著高于对照组(P<0.05)。抗nRNP抗体阳性者均为MCTD患者,抗Sm抗体、抗PCNA抗体和抗核小体抗体阳性者均为SLE患者,抗PM-Scl抗体阳性者均为PSS患者,抗AMA-M2抗体阳性者均为RA患者。对照组血清ANAs均为阴性。以血清ANA或ANAs任一项结果阳性作为诊断ANA的标准,则灵敏度、特异度、准确度分别为75.17%、100.00%和85.31%。结论 ANA联合ANAs检测对AID诊断具有极佳的特异性,前者具有较高的阳性检出率和灵敏度,后者在不同AID中阳性检出率差异较大,二者联合检测能够提高AID检出率,指导疾病诊断。

Objective To investigate the clinical accuracy of anti-nuclear antibody (ANA) combined with anti-nuclear antibodies spectrum (ANAs) in the diagnosis of autoimmune diseases (AID). Methods A total of 145 patients with AID (AID group) and 100 patients with non-AID (control group) admitted to our hospital from June 2016 to June 2018 were selected as study objects. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum ANA level. Western blotting was used to detect 14 specific antibodies such as serum against nRNP, Sm, SS-A (natural SS-A and Ro-52), SS-B, Scl-70, PM-Scl, Jo-1, CENP B, PCNA, dsDNA, ribosome, histone, ribosomal P protein and AMA-M2. Results No ANA positive was detected in the control group. A total of 97 cases were positive in the AID group, the positive rate was 66.90%. The highest ANA positive rate was 90.48% in SLE patients. The positive rate of ANA in the AID group and the positive rate of ANA in the each disease subgroup were significantly higher than that in the control group (P<0.05). All patients with antinRNP antibody positive were MCTD. All patients with anti-Sm, anti-PCNA or anti-nucleosome antibodies positive were SLE. The positive anti-PM-Scl antibodies were all PSS patients, and the positive anti-AMA-M2 antibodies were all RA patients. The serum ANAs in the control group were negative. The sensitivity, specificity and accuracy were 75.17%, 100.00% and 85.31%respectively when ANAor ANAs were positive as the diagnostic criteria for AID. Conclusion The combined detection of ANA and ANAs has excellent specificity for AID. The former has high positive detection rate and sensitivity, while the latter has great difference in positive detection rate among different AID diseases. The combined detection of the two methods can improve the detection rate of AID diseases and guide the diagnosis of diseases.