论文部分内容阅读
目的探讨抗核抗体(antinuclear antibody,ANA)和抗核抗体谱(antinuclear antibodies spectrum,ANAs)联合检测在自身免疫性疾病(autoimmune diseases,AID)诊断上的应用方案及价值,从而降低现症及潜在AID患者的漏检率。方法对1 231份本院门诊和住院疑似AID患者的血清标本分别采用间接免疫荧光法(indirect immunofluorescence,IIF)和免疫印迹法(immumoblottest,IBT)检测ANA和ANAs,对其中IIF-ANA1∶100(-)/IBT-ANAs(+)标本分别进行1∶10及1∶32稀释后采用IIF检测ANA,最后对上述检测结果进行统计分析。结果 1 231份血清标本中ANA阳性414份,占33.63%,ANAs阳性429份,占34.85%。按不同检测方案进行分组,发现同时检测IIF-ANA与IBT-ANAs的方案对确诊/疑似AID病人检出率最高(43.05%),分别与应用IIF-ANA进行AID的初筛的方案、仅检测IBT-ANAs的方案相比均有统计学意义(χ2=23.12,P<0.05,χ2=17.42,P<0.05)。对116份(9.42%)IIF-ANA 1∶100(-)/IBT-ANAs(+)的标本分别进行1∶32及1∶10稀释后再采用IIF检测ANA,发现其中103份标本ANA荧光结果≥1∶32,10份标本ANA荧光结果<1∶32而≥1∶10,3份标本ANA荧光结果<1∶10;将标本增加1∶32和1∶10稀释度可将AID确诊/疑似病例检出率分别提高8.37%(χ2=20.84,P<0.05)与9.18%(χ2=24.70,P<0.05),但二者之间相比则无统计学意义(χ2=0.17,P>0.5)。结论 IIF-ANA可应用于大范围AID病人初筛以减轻病人经济负担及实验室工作量压力。但是仅检测IIF-ANA或IBT-ANAs均可导致临床上患有AID或潜在的AID病人的漏检。联合检测IIF-ANA和IBT-ANAs,尤其是对临床高度怀疑AID、且ANA荧光结果≥1:32的标本进行IBT-ANAs的检测可显著提高检出率,从而降低现症及潜在AID患者的漏检率。
Objective To investigate the application of combined detection of antinuclear antibodies (ANAs) and antinuclear antibodies spectrum (ANAs) in the diagnosis of autoimmune diseases (AIDs), so as to reduce the incidence and potential AID patients missed the rate. Methods A total of 1 231 serum samples from outpatients and hospitalized suspected AID patients were tested for ANA and ANAs by indirect immunofluorescence (IIF) and immumoblottest (IBT) -) / IBT-ANAs (+) samples were diluted 1:10 and 1:32, respectively, followed by detection of ANA using IIF, and finally statistical analysis of the above test results. Results A total of 1 231 serum samples were positive for ANA, 414, accounting for 33.63%, 429 ANAs positive, accounting for 34.85%. According to the different detection schemes, we found that the detection of IIF-ANA and IBT-ANAs at the same time was the highest (43.05%) in patients with confirmed / suspected AID and the screening of AID with IIF-ANA was only detected IBT-ANAs were statistically significant (χ2 = 23.12, P <0.05, χ2 = 17.42, P <0.05). ANA was detected in 116 (9.42%) IIF-ANA 1: 100 (-) / IBT-ANAs (+) samples 1:32 and 1:10, respectively. 1:1:32, 10 samples ANA fluorescence results <1:32 and ≥ 1:10, 3 specimens ANA fluorescence results <1:10; the specimen increased 1:32 and 1:10 dilution AID can be confirmed / suspected The detection rate was 8.37% (χ2 = 20.84, P <0.05) and 9.18% (χ2 = 24.70, P <0.05), but there was no significant difference between the two groups ). Conclusion IIF-ANA can be used in screening a wide range of patients with AID to reduce the financial burden on patients and laboratory workload. However, the detection of either IIF-ANA or IBT-ANAs alone can result in undetected seizures in patients with clinically AID or potential AID. The combination of detection of IIF-ANA and IBT-ANAs, especially IBST-ANAs in clinically highly suspected AIDs with ANA fluorescence ≥1: 32, significantly improves the detection rate and reduces the incidence of Missing rate.