多方法学检测2657例血清自身抗体结果的回顾性分析  

Retrospective analysis of 2657 serum autoantibodies results detected by multiple methods

作　　者：车冬丽[1] 程亭瑄 杜金龙 刘晴[1] 田野[1] 史丽娜 王晓宁[1] 谢菲 古缘 谭延国[1] CHE Dongli;CHENG Tingxuan;DU Jinlong;LIU Qing;TIAN Ye;SHI Lina;WANG Xiaoning;XIE Fei;GU Yuan;TAN Yanguo(Department of Clinical Laboratory,Fuxing Hospital,Capital Medical University,Beijing 100038,China;College of Clinical Laboratory Medicine,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属复兴医院检验科,北京100038 [2]首都医科大学医学检验系,北京100038

出　　处：《国际检验医学杂志》2024年第23期2838-2843,共6页International Journal of Laboratory Medicine

基　　金：首都医科大学教育教学改革研究课题项目(2023JYY266)。

摘　　要：目的探讨常见自身抗体检测中不同方法学的检出情况,为自身抗体的检测策略提供依据。方法分析2657例同时使用间接免疫荧光(IIF)法检测抗核抗体(ANA)和免疫印迹(IB)法检测抗核抗体谱(ANAs,共15种靶抗原特异性抗体),使用IIF法、酶联免疫吸附试验(ELISA)和IB法同时检测抗双链DNA抗体(抗dsDNA抗体),以及2348例同时使用IIF法检测抗中性粒细胞胞浆抗体(ANCA)和ELISA检测ANCA谱[髓过氧化物酶抗体(抗MPO抗体)、抗蛋白酶3抗体(抗PR3抗体)]的结果。结果(1)ANA检出率显著高于ANAs(57.77%vs.30.64%,P<0.001),检出ANA者中,40.78%检出至少一种特异性抗体,且所有检出ANAs者中,未检出ANA者占23.10%。(2)检出ANA者以低滴度为主,≤1∶320者占总检出例数的84.95%,但滴度越高者,ANAs特异性抗体的检出率越高:依次为1∶100的29.63%、1∶320的48.56%、1∶1000的77.78%和≥1∶3200的92.42%。(3)在检出ANAs者中,抗Scl-70抗体、抗PM-Scl抗体、抗PCNA抗体在检出ANA者中的占比显著低于未检出ANA者(P<0.001)。(4)ELISA对抗dsDNA抗体的检出率最高(4.14%),高于IIF法和IB法(均P<0.001),且后两种方法检出率比较差异有统计学意义(P<0.001);即便如此,IIF法和IB法检测抗dsDNA抗体仍对ELISA具有一定的补充作用。⑸IIF法对ANCA的检出率显著高于ELISA对ANCA谱的检出率(9.16%vs.2.43%),但检出抗MPO抗体和/或抗PR3抗体者中,仍有47.37%(27/57)未检出ANCA。结论用于自身抗体检测的不同方法检测效能明显不同,根据循证医学制订正确的检测策略尤为必要。Objective To investigate the performance of different methods in common autoantibody detection,and to provide basis for the detection strategy of autoantibody.Methods A total of 2657 cases were included in this study,whose serum antinuclear antibody(ANA)by indirect immunofluorescence method(IIF)and antinuclear antibody spectrum(ANAs,a total of 15 antibodies)by immunoblot method(IB)were tested simultaneously,and anti-double strand DNA antibody(anti-dsDNA antibody)were tested by IIF,enzyme linked immunosorbent assay(ELISA)and IB.ANCA and ANCA spectrum[anti-myeloperoxidase antibody(anti-MPO antibody),anti-protease 3 antibody(anti-PR3 antibody)]were tested by IIF and ELISA respectively in 2348 cases.Results Firstly,the detection rate of ANA was significantly higher than that of ANAs(57.77%vs.30.64%,P<0.001).Among the specimens detected with ANA,40.78%detected at least one specific antibody positive.Among the specimens detected with ANAs positive,ANA was not detected in 23.10%of cases.Secondly,the ANA positive cases were mainly of lower titers,and cases with titer of≤1∶320 accounted for 84.95%of the total detected cases.But the higher the titer,the higher the detection rate of ANAs specific antibodies(29.63%in 1∶100,48.56%in 1∶320,77.78%in 1∶1000,92.42%in≥1∶3200).Thirdly,among the specimens detected ANAs positive,the composition ratios of anti-Scl-70,anti-PM-Scl and anti-PCNA antibodies in ANA positive cases was significantly lower than those in ANA negative cases(P<0.001).Fourthly,the detection rate of anti-dsDNA antibody by ELISA was the highest(4.14%),which was significantly higher than those by IIF or IB(both P<0.001),and the difference in detection efficacy of the latter two methods was also statistically significant(P<0.001).Even so,the IIF and IB for the detection of anti-dsDNA antibody still had a certain complementary effect on ELISA.Fifthly,the positive rate of ANCA by IIF was significantly higher than that of ANCA spectrum(9.16%vs.2.43%),but among those who were detected anti-MPO antibodies an

关 键 词：抗核抗体 抗核抗体谱 抗中性粒细胞胞浆抗体 抗双链DNA抗体 

分 类 号：R446.1[医药卫生—诊断学]