Prevalence and Factors Associated with Positivity of Antinuclear Antibodies (ANA) Patterns, Native Anti-DNA and Extractable Nuclear Antigens (ENA) Antibodies: Experience from a Laboratory in Dakar

Background: Diagnosis of autoimmune diseases (AID) is challenging, due to overlapping features with other non-immune disorders. Anti-nuclear antibodies (ANA) are sensitive screening tests but anti-deoxyribonucleic acid-antibody (anti-DNA), and anti-extractable nuclear antigens (anti-ENA) are specific for AIDs. We aimed to look at ANA patterns in our patients and correlated them with anti-ENA for proper interpretation and better patient management cost-effectively. Methods: A retrospective study was conducted over 1 year from January to December 2022 who were tested for ANA at biology medical laboratory of Pasteur Institute of Dakar. Anti-ENA and anti-DNA results were also analyzed for ANA-positive patients. Statistical analysis was performed using STATA 14.0, p Results: 216 patients were analyzed. Women predominated at 79.2% and mean age was 48 years [CI 95%, 46 - 50], with extremes of 10 and 89. Most represented age group was [41 - 60] with 38%. ANA was positive in 27 (12.5%) of patients, 59.2% of whom were strongly positive (titer of 1/1000, 1/3200 or 1/6400). The most common pattern was nuclear speckled, which was found in 77.8% of samples. Anti-ENA and anti-DNA positivity in ANA-positive patients was found respectively in 63% (17/27) and 1.4% (3/27) of the samples analyzed. Most commonly identified anti-ENA was anti-Sm 29.6%, anti-SSA 29.6%, anti-Ro-52 25.9%, anti-RNP 18.5% and anti-SSB 14.8% which was associated with speckled pattern. Association results indicated a significant relationship between both tests and between ANA titer in the anti-ENA- and ANA-positive patients (p 0.001). Conclusions: ANA, Anti-ENA and anti-DNA antibodies are essential for AIDS diagnosis. However, the testing repertoire should follow an algorithm comprising of clinical features, followed by ANA results with nuclear, mitotic, and cytoplasmic patterns, anti-ENA, and anti-DNA for a more meaningful, and cost-effective diagnostic approach.

Detection of Antinuclear Antibodies in Canine Serum by Immunoperoxidase in MDCK and Indirect Immunofluorescence in HEp2 Cells

Antinuclear antibodies are found in animals suffering from Systemic Lupus Erythematosus (SLE) and some other diseases, their presence in the blood is determined by antinuclear antibody (ANA) test using indirect immunofluorescence (IF) with HEp2 cells as a substrate. In this work, an immunoperoxidase (IP) assay was developed to evaluate the ANAs in canine sera, using canine kidney cell lines (MDCK) and compared with a commercial immunofluorescence test on Hep2 cells for this system, a fluoresceinated anti-canine Ig antibody was standardized. The study was performed on 50 sera from dogs submitted to the laboratory with different clinical diagnoses of autoimmune-associated diseases. The procedures on both cells were unified to perform comparisons of the reactions, direct sera or at different dilutions were added to a monolayer of permeabilized MDCK cells, followed by a peroxidized anti-canine IgG conjugate, and a substrate for the IP reaction. The same sera were tested on the commercial IF assay on Hep2 cell system. In 22/50 cases, the presence of LE cells in peripheral blood was determined. A high correlation was found in the detection of antinuclear antibodies between both cell lines and techniques, however there were differences in the reaction patterns in the nucleus and cytoplasm between cell lines. The diffuse nuclear pattern observed in MDCK cells was more related to the presence of high percentages of LE cells in peripheral blood. The differences found in the results were possibly associated with the presence of homologous antigens between the MDCK cells and the dog. In addition, the methodology and standardization for the use and interpretation of a reference serum was developed to unify the interpretation criteria in the laboratory.

Clinical value of chemiluminescence method for detection of antinuclear antibody profiles

BACKGROUND Antinuclear antibodies(ANAs)are crucial in diagnosing autoimmune diseases,mainly systemic lupus erythematosus(SLE).This study aimed to compare the performance of chemiluminescence assay(CLIA)and line immunoassay(LIA)in detecting ANAs in patients with autoimmune diseases,evaluate their diagnostic accuracy for SLE,and develop a novel diagnostic model using CLIA-detected antibodies for SLE.Specimens from patients with autoimmune diseases and physical examination specimens were collected to parallel detect specific antibodies.Individual antibodies'diagnostic performance and a model combining multiple antibodies were assessed.The findings provide valuable insights into improving the diagnosis of SLE through innovative approaches.AIM To compare the performance of CLIA and LIA in detecting ANAs in patients with autoimmune diseases,assess their accuracy for SLE,and develop a novel diagnostic model using CLIA-detected antibodies for SLE.METHODS Specimens have been obtained from 270 patients with clinically diagnosed autoimmune disorders,as well as 130 physical examination specimens.After that,parallel detection of anti-double-stranded DNA(dsDNA)antibody,anti-histone(Histone)antibody,anti-nucleosome(Nuc)antibody,anti-Smith(Sm)antibody,anti-ribosomal P protein(Rib-P)antibody,anti-sicca syndrome A(Ro60)antibody,anti-sicca syndrome A(Ro52)antibody,anti-sicca syndrome(SSB)antibody,anticentromere protein B(Cenp-B)antibody,anti-DNA topoisomerase 1(Scl-70)antibody,anti-histidyl tRNA synthetase(Jo-1)antibody,and anti-mitochondrial M2(AMA-M2)antibody was performed using CLIA and LIA.The detection rates,compliance rates,and diagnostic performance for SLE were compared between the two methodologies,followed by developing a novel diagnostic model for SLE.RESULTS CLIA and LIA exhibited essentially comparable detection rates for anti-dsDNA antibody,anti-Histone antibody,anti-Nuc antibody,anti-Sm antibody,anti-Rib-P antibody,anti-Ro60 antibody,anti-Ro52 antibody,anti-SSB antibody,anti-Cenp-B antibody,anti-DNAScl-70 antibody,anti-Jo-1 antibody and anti-AMA-M2 antibody(P>0.05).The two methods displayed identical results for the detection of anti-dsDNA antibody,anti-Histone antibody,anti-Nuc antibody,anti-Sm antibody,anti-Ro60 antibody,anti-Ro52 antibody,anti-SSB antibody,anti-Cenp-B antibody,anti-Scl-70 antibody,and anti-AMA-M2 antibody(Kappa>0.7,P<0.05),but showed a moderate agreement for the detection of anti-Rib-P antibody and anti-Jo-1 antibody(Kappa=0.671 and 0.665;P<0.05).In addition,the diagnostic performance of these antibodies detected by both methods was similar for SLE.The diagnostic model's area under the curve values,sensitivity,and specificity,including an anti-dsDNA antibody and an anti-Ro60 antibody detected by CLIA,were 0.997,0.962,and 0.978,respectively.These values were higher than the diagnostic performance of individual antibodies.CONCLUSION CLIA and LIA demonstrated excellent overall consistency in detecting ANA profiles.A diagnostic model based on CLIA-detected antibodies can successfully contribute to developing a novel technique for detecting SLE.

Role of autoantibodies in the clinical management of primary biliary cholangitis

Primary biliary cholangitis(PBC)is a chronic cholestatic liver disease characterized by immune-driven destruction of small intrahepatic bile ducts leading a proportion of patients to hepatic failure over the years.Diagnosis at early stages in concert with ursodeoxycholic acid treatment has been linked with prevention of disease progression in the majority of cases.Diagnosis of PBC in a patient with cholestasis relies on the detection of disease-specific autoantibodies,including anti-mitochondrial antibodies,and disease-specific anti-nuclear antibodies targeting sp100 and gp210.These autoantibodies assist the diagnosis of the disease,and are amongst few autoantibodies the presence of which is included in the diagnostic criteria of the disease.They have also become important tools evaluating disease prognosis.Herein,we summarize existing data on detection of PBC-related autoantibodies and their clinical significance.Moreover,we provide insight on novel autoantibodies and their possible prognostic role in PBC patients.

Positive autoantibodies in living liver donors

BACKGROUND There is a nationwide shortage of organs available for liver transplantation.Living donors help meet this growing demand.Not uncommonly,donors will have positive autoantibodies.However,it is unclear whether donor positive autoantibodies are correlated with worse outcomes following living liver donor transplantations.AIM To analyze the significance of positive autoantibodies in donors on post-transplant outcomes in recipients.METHODS We performed a retrospective review of living liver donors who had undergone liver transplantation between January 1,2012 and August 31,2021.Demographic characteristics and pre-transplant data including antinuclear antibodies(ANA)and anti-smooth muscle antibody titers were collected in donors.Outcomes of interest were post-transplantation complications including mortality,biliary strictures,biliary leaks,infection,and rejection.Pediatric recipients and donors without measured pre-transplant autoantibody serologies were excluded from this study.RESULTS 172 living donor liver transplantations were performed during the study period,of which 115 patients met inclusion criteria.37(32%)living donors were autoantibody-positive with a median ANA titer of 1:160(range 1:80 to 1:1280)and median anti-SMA titer of 1:40(range 1:20 to 1:160).There were no significant differences in baseline demographics between the autoantibody positive and negative donors.Post-transplantation rates of death(P value=1),infections(P value=0.66),and overall rates of complications(P value=0.52)were similar between the autoantibody positive and negative groups.Higher incidences of anastomotic strictures and rejection were observed in the autoantibody positive group;however,these differences were not statistically significant(P value=0.07 and P value=0.30 respectively).CONCLUSION Isolated pre-transplant autoantibody positivity is not correlated to worse post-transplant outcomes in living liver donor transplants.

Peri-nuclear antibodies correlate with survival in Greek primary biliary cirrhosis patients

AIM:To investigate possible associations of anti-nuclear envelope antibody(ANEA)with disease severity and survival in Greek primary biliary cirrhosis(PBC)patients.METHODS:Serum samples were collected at diagnosis from 147 PBC patients(85%female),who were followed-up for a median 89.5 mo(range 1-240).ANEA were detected with indirect immunofluorescence on 1% formaldehyde fixed Hep2 cells,and anti-gp210 antibodies were detected using an enzyme linked immunosorbent assay.Findings were correlated with clinical data,histology,and survival.RESULTS:ANEA were detected in 69/147(46.9%) patients and 31/147(21%)were also anti-gp210 positive.The ANEA positive patients were at a more advanced histological stage(Ⅰ-Ⅱ/Ⅲ-Ⅳ56.5%/43.5% vs 74.4%/25.6%,P=0.005)compared to the ANEA negative ones.They had a higher antimitochondrial antibodies(AMA)titer(≤1:160/>1:160 50.7%/49.3%vs 71.8%/28.2%,P=0.001)and a lower survival time(91.7 ±50.7 mo vs 101.8±55 mo,P=0.043).Moreover,they had more advanced fibrosis,portal inflammation,interface hepatitis,and proliferation of bile ductules(P =0.008,P=0.008,P=0.019,and P=0.027,respectively).They also died more frequently of hepatic failure and/or hepatocellular carcinoma(P=0.016).ANEA positive,anti-gp210 positive patients had a difference in stage(Ⅰ-Ⅱ/Ⅲ-Ⅳ54.8%/45.2%vs 74.4%/25.6%,P= 0.006),AMA titer(≤1:160/>1:160 51.6%/48.4%vs 71.8%/28.2%,P=0.009),survival(91.1±52.9 mo vs 101.8±55 mo,P=0.009),and Mayo risk score(5.5 ±1.9 vs 5.04±1.3,P=0.04)compared to the ANEA negative patients.ANEA positive,anti-gp210 negative patients had a difference in AMA titer(≤1:160/>1:160 50%/50%vs 71.8%/28.2%,P=0.002),stage(Ⅰ-Ⅱ/Ⅲ -Ⅳ57.9%/42.1%vs 74.4%/25.6%,P=0.033),fibrosis(P=0.009),portal inflammation(P=0.018),interface hepatitis(P=0.032),and proliferation of bile ductules(P=0.031).Anti-gp210 positive patients had a worse Mayo risk score(5.5±1.9 vs 4.9±1.7,P=0.038)than the anti-gp210 negative ones.CONCLUSION:The presence of ANEA and anti-gp210 identifies a subgroup of PBC patients with advanced disease severity and poor prognosis.

Autoantibodies in chronic hepatitis C: A clinical perspective

Non-organ-specific autoantibodies and thyroid autoantibodies have been frequently found in chronic carriers of hepatitis C virus(HCV). With respect to endomysial antibodies and tissue transglutaminase, it is controversial whether the prevalence of glutenrelated seromarkers is higher in patients with HCV. In such cases, in addition to acknowledging any currently existing autoimmune disease, recognizing the risk of the patient developing an autoimmune disease during interferon(IFN)-based treatment must be a principle concern. From a clinical point-of-view, the presence of autoantibodies arouses suspicion that an autoimmunedisease may be present or may be precipitated by IFNbased HCV treatment. In this paper, we review the prevalence of autoantibodies in individuals with hepatitis C, the clinical significance of these autoantibodies, and the approach recommended for such situations.

Presence of serum antinuclear antibodies correlating unfavorable overall survival in patients with chronic lymphocytic leukemia

Background: Serum antinuclear antibodies (ANAs) are positive in some patients with chronic lymphocytic leukemia (CLL), prognostic value of ANAs remains unknown. The aim of this study was to evaluate the role of ANAs as a prognostic factor in CLL. Methods: This study retrospectively analyzed clinical data from 216 newly diagnosed CLL subjects with ANAs test from 2007 to 2017. Multivariate Cox regression analyses were used to screen the independent prognostic factors related to time to first treatment (TTFT), progression free survival (PFS) and overall survival (OS). Receiver operator characteristic curves and area under the curve (AUC) were utilized to assess the predictive accuracy of ANAs together with other independent factors for OS. Results: The incidence of ANAs abnormality at diagnosis was 13.9%. ANAs positivity and TP53 disruption were independent prognostic indicators for OS. The AUC of positive ANAs together with TP53 disruption was 0.766 (95% confidence interval [CI]: 0.697-0.826), which was significantly larger than that of either TP53 disruption (AUC:0.706, 95% CI:0.634-0.772, P=0.034) or positive ANAs (AUC:0.595, 95% CI:0.520-0.668,P<0.001) in OS prediction. Besides, serum positive ANAs as one additional parameter to CLL-international prognostic index (IPI) obtained superior AUCs in predicting CLL OS than CLL-IPI alone. Conclusion: This study identified ANAs as an independent prognostic factor for CLL, and further investigations are needed to validate this finding.

Clinical evaluation of serum antimitochondrial antibody-negative primary biliary cirrhosis

BACKGROUND: Primary biliary cirrhosis (PBC) is cha- racterized by frequent presence of antimitochondrial anti- bodies (AMAs). The sensitivity and specificity of AMA for PBC are both greater than 90%-95%, so the presence of AMA in serum is the major hallmark in PBC. However, it has long been recognized that in 5%-10% of patients the clinical, biochemical and histological features are diagnos- tic for PBC, but their sera are consistently tested negative for AMA/AMA-M2. This study aimed to evaluate whether the presence of AMA alters the clinical, serological and his- tological features of the disease. METHODS: Clinical data of 70 patients clinically and/or histologically diagnosed with PBC were reviewed. AMA- negative and AMA-positive patients were compared in terms of clinical, biochemical, immunological and histo- logical features. RESULTS: At presentation, 11 patients were serum AMA/ AMA-M2 negative. At the initial visit, AMA-negative and AMA-positive patients were similar in terms of age, sex, clinical manifestations, liver biochemistries and histological findings. The mean level of serum immunoglobulin M (IgM) was significantly lower in AMA-negative PBC pa- tients than in AMA-positive PBC patients (2851±1418 mg/L vs 6361 ±4928 mg/L, P =0.033). Serum antinuclear anti- bodies ( ANA) and/or smooth muscle antibodies ( SMA) were more frequently positive in the AMA-negative PBC patients than in the AMA-positive patients (81.8% vs 40.7%, P =0.031). CONCLUSION: AMA-negative PBC patients are characte- rized by relatively lower levels of serum IgM and a higher prevalence of serum ANA/SMA and are not associated with substantial differences in the clinical, biochemical and histo- logical spectrum of the disease.

抗核抗体阳性及干预治疗与反复种植失败辅助生殖结局相关性研究

目的探讨抗核抗体(ANA)阳性及干预治疗对反复种植失败(RIF)患者辅助生殖结局的影响。方法回顾性研究344例RIF患者,根据ANA检测结果分为ANA阳性组(294例)和阴性对照组(50例),抗核抗体阳性组分为ANA阳性低滴度组(214例)和ANA阳性高滴度组(80例)。比较阳性组和阴性组患者的一般临床资料、胚胎相关数据以及妊娠结局。采用Wilcoxon秩和检验、Mann-Whitney U检验、Kruskal-Wallis检验和卡方检验的统计学方法来分析ANA对RIF患者辅助生殖结局的影响,并分析了ANA阳性患者进行干预治疗后的临床妊娠情况。结果ANA阳性低滴度组和高滴度组患者临床妊娠率均显著低于阴性对照组(P<0.001);ANA阳性患者卵细胞受精率和卵裂率也均显著低于阴性对照组(P<0.05);因ANA阳性胚胎移植后未妊娠患者,经免疫调节剂治疗后的单周期临床妊娠率和累积临床妊娠率均明显提升(P<0.05)。结论与阴性对照组相比,ANA低滴度阳性和高滴度阳性患者的临床妊娠率均下降。经过临床干预治疗后,ANA阳性患者的单周期临床妊娠率和累积妊娠率得到了改善。这表明ANA阳性是RIF的重要原因,而免疫调节剂治疗是改善ANA阳性患者辅助生殖结局的有效措施。

抗核抗体谱对AIH-PBC OS及单纯AIH患者激素应答的影响

目的探讨抗核抗体谱(ANAs)对自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征(AIH-PBC OS)及单纯AIH患者半年内激素应答的影响。方法回顾性分析2018年1月-2021年12月兰州大学第一医院收治的77例自身免疫性肝病(AILD)患者的资料,其中AIH-PBC OS组46例,单纯AIH组31例。均经肝穿刺活检组织病理检查确诊,并行糖皮质激素治疗。比较两组患者的一般临床特征、肝穿刺相关指标、自身抗体及免疫球蛋白指标,以及患者使用糖皮质激素初始及6个月内复查的生化及免疫球蛋白指标,根据谷草转氨酶(AST)、谷丙转氨酶(ALT)及免疫球蛋白G(IgG)水平评估治疗6个月内的激素应答情况,采用多因素有序logistic分析ANAs对两组患者激素应答结果的影响。结果ANAs阳性及阴性AILD患者中,AIH-PBC OS及单纯AIH患者占比均无统计学差异(55.6%vs.44.4%,65.6%vs.34.4%,P>0.05)。46例AIH-PBC OS患者中,ANAs阳性组25例,ANAs阴性组21例。ANAs阳性组半年内激素完全应答率低于ANAs阴性组(44.0%vs.76.2%),而激素不应答率高于ANAs阴性组(20.0%vs.0),差异有统计学意义(P<0.05)。31例单纯AIH患者中,ANAs阳性组20例,ANAs阴性组11例。两组患者半年内激素应答结果差异无统计学意义(P>0.05)。多因素有序logistic分析结果显示,AIHPBC OS患者中,ANAs阳性者半年内激素不应答的可能性较大,差异有统计学意义(P<0.05)。而单纯AIH患者中ANAs类型对激素应答结果无明显影响(P>0.05)。结论在AIH-PBC OS患者中,ANAs阳性者半年内激素应答结果欠佳;在单纯AIH患者中,ANAs对激素应答结果无明显影响。

原发性干燥综合征并肝损害13例临床特征及中医证型分析

目的:分析原发性干燥综合征并肝损害临床特征及中医证型状况,为早期改善患者预后提供参考。方法:选择2018年9月至2022年1月广州中医药大学东莞医院风湿科诊治的原发性干燥综合征患者72例作为研究对象,调查、记录患者的电子病历系统,随访患者的预后,重点记录临床特征及中医证型。结果:72例患者中肝损害13例,占比18.1%,女性13例,临床上首发主要症状以口干、眼干为主。肝损害以GGT、ALP升高为主,ALT、AST升高不明显,13例患者均出现抗核抗体(ANA)阳性,中医分型判定为肝郁脾虚型6例、脾肾不足型4例、气阴两虚型2例、阴虚津亏型1例。13例患者经过中西医结合治疗后都顺利出院,2~3周后复查肝功能恢复至正常。结论:临床医师应对原发性干燥综合征肝损害、自身免疫性肝病的异同有充分认识,分析各种实验室检查结果,及早明确诊断、分析中医证型并给予相应治疗方案。

广东地区人群抗核抗体检测滴度及核型特征分析

目的通过分析广东地区抗核抗体(antinuclear antibody,ANA)受试者滴度及核型阳性检出情况,探讨ANA阳性人群的临床特征,便于为广东地区人群的健康管理提供科学依据,为潜在的自身免疫性疾病(autoimmune diseases,AID)患者提供早期健康指导和参考。方法回顾性分析2021年4月至2023年7月广东地区22家医院通过间接免疫荧光法(indirect immunofluorescence,IIF)常规检测ANA的患者23771例,统计ANA滴度、核型阳性检出率及性别、年龄特征。结果23771例ANA检测患者阳性检出率为14.21%(3378/23771),随年龄增大ANA阳性患者数量呈递增趋势,60岁以上ANA阳性有1440例(42.63%)人数最多。不同年龄段ANA阳性检出率女性均高于男性。滴度以1∶80抗体低滴度为主,有2662例(78.81%),高滴度1∶1000与1∶1280阳性率均较低,其中颗粒型阳性检出2288例(67.73%)最高,60岁以上有879例(46.31%)人数最多,但男女颗粒型阳性率差距随着年龄增加逐渐缩短。结论广东地区女性ANA阳性检出率较高,其中1∶80颗粒型最多,提示患有系统性红斑狼疮、混合性结缔组织病、干燥综合征或多发性肌炎等疾病有较大的风险,尤其是绝经后的中老年女性,同时60岁以上的男性也应多留意发生免疫疾病的风险。

误诊为肺结核瘤的ANCA相关性血管炎临床分析

目的探讨抗中性粒细胞胞质抗体(ANCA)相关性血管炎的误诊原因及防范措施。方法回顾分析1例曾误诊的ANCA相关性血管炎的临床资料。结果本例因下肢红疹伴溃疡入院。曾行“鼻窦炎”手术,术前筛查发现肺部肿物行“肺部肿物切除术”,术后病理示肺结核瘤,抗结核治疗无效。入院后结合患者多系统受累表现及实验室、肾穿刺病理检查等诊断为ANCA相关性血管炎,给予糖皮质激素及调节免疫等治疗,症状缓解。结论ANCA相关性血管炎临床表现多样且不典型,易误诊。临床中应对疑似病例尽早行相关医技检查。

7803例患儿血清ANA检测结果及其与疾病的关系

目的探讨血清抗核抗体(ANA)在不同疾病患儿中的分布特征,及其与疾病的关系。方法选取2016年1月—2021年11月上海交通大学医学院附属新华医院住院患儿7803例,采用间接免疫荧光法(IIF)和线性免疫印迹法(LIA)检测ANA。根据出院诊断将所有患儿分为抗核抗体相关风湿免疫性疾病(AARD)组(296例)、其他风湿病(ORD)组(2314例)、非风湿病(NRD)组(5128例)、高度怀疑AARD但未明确诊断(UD)组(65例)。根据ANA检测结果分为IIF-LIA-、IIF+LIA-、IIF-LIA+和IIF+LIA+共4种模式,其中IIF-LIA-模式为ANA阴性,其他3种模式为ANA阳性。结果7803例患儿中ANA阳性1550例(19.9%),AARD组ANA阳性率最高(81.8%),显著高于ORD组、NRD组和UD组(P<0.05)。AARD组ANA双阳性(IIF+LIA+)检出率最高(48.3%),且ANA双阳性对AARD的诊断似然比为27.03。在LIA阳性样本中,检出率居前3位的抗体分别为抗SS-A抗体[33.2%(168/506)]、抗双链DNA(dsDNA)抗体[24.1%(122/506)]、抗组蛋白抗体[18.0%(91/506)]。AARD组常见的2种ANA荧光核型为颗粒型(41.9%)和均质型(30.7%),且以高滴度为主。ANA滴度诊断AARD的受试者工作特征(ROC)曲线下面积为0.8702,最佳临界值为1∶80,敏感性为71.3%,特异性为93.5%;随着滴度的增加,对应的似然比呈对数性增加。结论在儿童群体中,IIF和LIA检测ANA各有优势,互相不可替代。ANA双阳性、高滴度对AARD具有重要的诊断价值,建议将似然比纳入ANA的检测报告。

自身抗体在自身免疫性脑炎中临床价值分析

目的全身性自身抗体对自身免疫性疾病的诊断很重要,但其在自身免疫性脑炎(autoimmune encephalitis,AE)中的作用尚不清楚。本研究的目的是探讨自身抗体在自身免疫性脑炎中临床价值。方法评估抗NMDAR脑炎患者和其他形式自身免疫性脑炎患者的全身性自身抗体,根据自身抗体将脑炎患者分为抗核抗体(ANA)阳性组和(ANA)阴性组进行分组比较。结果共纳入194例AE患者进行了抗核抗体谱检测,结果显示AE中自身抗体总体阳性率为35.10%,70例抗NMDAR脑炎患者中抗体的阳性率(32.86%),显著高于49例抗LGI1脑炎患者(26.53%),其中以低滴度的ANA荧光核型常见,荧光核型主要以核颗粒型多见;ANA不同组中血清神经元抗体滴度差异具有统计学意义(P=0.032),说明血清自身抗体与血清中神经元抗体具有相互作用。结论自身抗体在自身免疫性脑炎患者检测中具有重要意义,阳性可能通过与针对神经元表面抗原与抗体相互作用而导致大脑的免疫功能紊乱,常见的自身抗体甚至到荧光核型可能为患者初步诊疗制定提供重要参考。

流式荧光免疫法检测抗核抗体谱在自身免疫性疾病中的诊断价值

目的探讨流式荧光免疫法检测抗核抗体谱在自身免疫性疾病(AID)中的诊断价值。方法选取2021年12月至2022年9月在该院就诊的269例AID患者作为AID组,另选取同期在该院体检的40例健康体检者作为正常对照组,以及51例非AID(消化系统疾病、呼吸系统疾病等)患者作为疾病对照组。采用流式荧光免疫法和免疫印迹法检测所有研究对象血清的抗核抗体谱,进行一致性评价,分析两种方法的灵敏度和特异度。结果以免疫印迹法作为金标准,流式荧光免疫法检测各组360例样本的灵敏度为92.64%,特异度为83.33%,准确度为90.00%,Kappa值为0.755;AID组中不同抗体的准确度为72.12%~98.51%,Kappa值为0.281~0.874。结论以免疫印迹法为金标准,流式荧光免疫法检测抗核抗体谱诊断AID的准确度较高,可同时检测不同抗体并精准定量,大大减少了实验室工作量,将会成为新一代的抗核抗体谱检测方法。

抗核抗体与低分子肝素治疗不明原因复发性流产子宫胎盘血流指数的关系

目的探讨抗核抗体(ANA)与低分子肝素(LMWH)治疗不明原因复发性流产(URSA)孕妇子宫胎盘血流指数的关系。方法2020年1月至2022年12月期间,共纳入80例URSA孕妇,其中40例接受LMWH治疗,另外40例未接受LMWH治疗,2组ANA阴性(-)和ANA阳性(+)各20例。借助虚拟器官计算机辅助分析技术进行2D多普勒测量子宫动脉搏动指数(PI)和3D超声测定血管化指数(VI)、血流指数(FI)和血管化血流指数(VFI),并对所有女性进行血清ANA测定。结果未接受LMWH治疗和接受LMWH治疗的ANA(-)URSA孕妇分娩孕周、新生儿结局比较,差异具有统计学意义(P<0.05)。无论ANA状态如何,未接受LMWH治疗和接受LMWH治疗的URSA孕妇间PI、VFI、FI值差异均无统计学意义(P>0.05)。而接受LMWH治疗的ANA(-)URSA孕妇VI值显著高于未接受LMWH治疗的ANA(-)URSA孕妇(20.02±6.06 vs 11.60±3.04,P<0.001)。仅考虑ANA(-)URSA患者,VI用于区分接受和未接受LMWH治疗孕妇的ROC曲线下面积为0.889(标准误=0.053,P<0.001,95%置信区间=0.785~0.993),VI临界值为16.05,灵敏度为75.0%,特异性为100.0%。结论LMWH可能对于恢复ANA(-)状态下URSA女性VI的生理血流供应具有潜在的有益作用,但是仍需要更进一步的研究来解释彼此之间的关系。

核仁型抗核抗体在自身免疫性疾病中的临床意义

目的 探讨核仁型抗核抗体(ANA)在相关疾病中的临床意义。方法 该研究为回顾性研究,收集2017年1月至2022年5月该院就诊患者临床样本71 780例,采用间接免疫荧光法检测临床标本的ANA,统计核仁型ANA在临床就诊患者中的阳性率,以及核仁型ANA阳性自身免疫性疾病(AID)患者的相关临床信息和实验室特征。结果 在71 780例患者ANA常规检测中,ANA阳性的有16778例,阳性率为23.37%。其中核仁型有1708例,占所有ANA常规检测的2.38%,在ANA阳性者中的比例为10.18%。>20~<50岁组和≥50岁组中不同性别患者核仁型ANA阳性率比较差异有统计学意义(P<0.05),而≤20岁组中不同性别患者核仁型ANA阳性率比较差异无统计学意义(P>0.05)。不同年龄组女性的核仁型ANA阳性率比较差异有统计学意义(P<0.05),其中以>20~<50岁组女性核仁型ANA阳性率为最高。不同年龄组男性核仁型ANA阳性率比较差异无统计学意义(P>0.05)。ANA阳性率以风湿免疫科患者为最高(70.35%),但核仁型ANA阳性主要见于生殖医学中心(12.90%)、呼吸内科(12.40%)及神经内科(11.29%)等科室,且科室间的阳性率差异有统计学意义(P<0.05)。1708例核仁型ANA阳性者中,420例做了ANA滴度,包括34例AID患者,386例非AID患者。核仁阳性滴度在非AID患者与AID患者之间的差别无统计学意义(P>0.05)。结论 核仁型是ANA阳性者中的常见荧光模式,在ANA阳性者中存在性别和年龄差异;核仁型ANA阳性率和滴度在不同AID疾病中均存在差异。联合其他免疫功能指标检测,有助于早期鉴别诊断AID。

以消化道症状首发的系统性红斑狼疮误诊原因探析

目的分析以消化道症状为首发表现的系统性红斑狼疮(SLE)的误诊原因,并总结防范误诊措施。方法回顾性分析2013年12月—2023年9月曾误诊的3例SLE的临床资料。结果3例均以消化道症状为首发表现就诊。1例误诊为急性胃炎、肠梗阻,1例误诊为感染性腹泻、急性胃肠炎、胃肠道痉挛,1例误诊为急性肠炎。误诊时间7~30 d。3例入院后经追问病史、详细查体,完善血液免疫学指标、肾穿刺病理学检查后明确诊断为SLE,给予糖皮质激素治疗后症状缓解。3个月后随访症状消失。结论SLE临床表现多样,以消化道症状首发的早期SLE不易诊断,临床医师应提高警惕,减少或避免误诊误治。