间接免疫荧光法筛查抗核抗体与特异性抗体检测的相互关系  

Relationship between Anti-nuclear Antibodies and the Detection of Specific Anti-nuclear Antibodies

作　　者：胡朝军[1] 李俊[1,2] 张道强[1,3] 张蜀澜[1] 李丽君[1] 董晓娟[1] 张奉春[1] 李永哲[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院风湿免疫科,北京100032 [2]浙江省台州医院检验科,浙江台州317000 [3]山东省威海市文登中心医院检验科,山东威海264400

出　　处：《中华临床免疫和变态反应杂志》2011年第3期179-185,共7页Chinese Journal of Allergy & Clinical Immunology

基　　金：国家自然科学基金(30640084;30872331;81072486);国家十一五科技支撑计划(2008BAI59B02;2008BAI59B03);北京协和医院青年基金(I101430);威海市科技发展计划(2008093-8)

摘　　要：目的分析以间接免疫荧光法(indirect immunofluorescence,IIF)筛查的大样本抗核抗体(antinuclear antibody,ANA)结果与特异性抗体检测结果的相互关系,以确定其临床意义及临床实践中二者是否能够相互代替。方法采用IIF筛查2026份临床连续送检血清标本的ANA,采用线性免疫印迹法(line immunoassay,LIA)检测ANAs特异性抗体,将2026份标本分为自身免疫性疾病(autoimmune diseases,AID)组、疑似AID组、非AID组,分析检测结果的相互关系和临床意义。结果 2026份标本中,IIF阳性/LIA阳性882份,占43.53%;IIF阳性/LIA阴性266份,占13.13%;IIF阴性/LIA阴性507份,占25.02%,IIF阴性/LIA阳性206份,占10.17%。IIF与LIA检测ANA的结果总体符合率为68.56%(K=0.472,P<0.01),2种方法检测结果的差异有统计学意义(χ2=416.21,P<0.01)。IIF阴性/LIA非阴性组中,抗Ro-52、抗干燥综合征抗原A(SS-A)、抗双链DNA(dsDNA)、抗线粒体抗体M2亚型(AMA-M2)、抗史密斯抗原(Sm)、抗干燥综合征抗原B(SS-B)、抗核糖核蛋白/史密斯抗原(nRNP/Sm)和抗组氨酰tRNA合成酶抗原(Jo-1)抗体的阳性率分别为6.00%～34.94%;IIF阴性/LIA非阴性的312例患者中,AID患者116例,占37.18%,高于非AID患者(22.11%),且差异有统计学意义(χ2=16.97,P<0.01)。IIF阳性/LIA非阳性的325例患者中,AID患者156例,占48.00%,高于非AID患者(22.15%),而且AID患者在IIF-ANA滴度1:80、1:160～1:320和≥1:640各组中的比例均高于非AID患者,其差异有统计学意义(χ2=26.96、χ2=7.89、χ2=19.42,P<0.01)。结论 IIF筛查ANA容易导致AID患者部分具有重要临床意义的ANA特异性抗体漏检,而ANA特异性抗体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筛查和LIA-ANAs特异性抗体检测不能相互代替,对需要通过检测ANA来排除AID的患者标本应同时进行IIF-ANA筛查和ANAs特异性抗体的检测,以避免仅采用1种方法进行检测时导致的AID患者漏诊。Objective To analyze the correlation between the antin-uclear antibody（ANA） results of large samples by indirect immunofluorescence（IIF） screening and specific anti-nuclear antibodies test and study the clinical significance of them and clarify whether they could replace each other in clinical practice.Methods 2 026 cases of consecutive clinical samples for ANA testing were tested by IIF with HEp-2 and line immunoassay（LIA） for the detection of specific ANA antibodies.All the samples were divided into autoimmune diseases（AID） group,suspected AID group and non-AID group.The relationship between different test results and their clinical significance were analyzed.Results Of the 2 026 cases of specimens,882 cases（43.53%） were IIF-ANA＋/LIA-ANAs＋,266 cases（13.13%） were IIF-ANA＋/LIA-ANAs-,507 cases（25.02%） were IIF-ANA-/LIA-ANAs-and 206 cases（10.17%） were IIF-ANA-/LIA-ANAs＋.The overall compliance rate of IIF-ANA and LIA-ANA was 68.56%,the consistency rate was moderate（K=0.472,P0.01）,and there was significant difference between the results of IIF-ANA and LIA-ANA（χ2=416.21,P0.01）.The positive rates of anti-Ro-52,anti-SS-A（Sjogren＇ s syndrome antigen A）,anti-dsDNA（double-stranded DNA）,anti-AMA-M2（Anti-mitochondrial antibody M2）,anti-Sm（Smith antigen）,anti-SS-B（Sjogren＇ s syndrome antigen B）,anti-nRNP/Sm（nuclear ribonucleoprotein/Smith antigen）and anti-Jo-1（Jo-1 antigen） antibodies ranged from 6.00% to 34.94% in the IIF-ANA-/LIA-ANAs＋/± group.Of the 312 cases of this group,37.18% patients（116 cases） were diagnosed as AID,higher than the non-AID group（22.11%）（χ2=16.97,P0.01）.Of the 325 cases of IIF-ANA＋/LIA-ANAs-/±group,48.0% of patients（156 cases） were diagnosed as AID,higher than the non-AID group（22.15%）,and the proportion of patients with AID was higher than non-AID in each group of patients with IIF-ANA titer 1：80,1：160-1：320 and ≥1：640（χ2=26.96,7.89,19.42,P0.01）.Conclusions It has a tendency to mi

关 键 词：间接免疫荧光法 抗核抗体 免疫印迹法 敏感性 特异性 

分 类 号：R446.6[医药卫生—诊断学] R593.2[医药卫生—临床医学]