Roberts-Thomson Peter J, Nikoloutsopoulos Tony, Cox Sally, Walker Jennifer G, Gordon Tom P
Department of Immunology, Allergy and Arthritis, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia.
Immunol Cell Biol. 2003 Oct;81(5):409-12. doi: 10.1046/j.1440-1711.2003.01181.x.
A systematic review has been undertaken of antinuclear antibody testing over a 6-year period in a regional immunotherapy laboratory servicing a population of 400 000. Twenty-eight per cent of the 20 205 antinuclear antibody tests performed on a hyperexpressing Ro transfected cellular substrate were positive (titre >/= 1 : 80) with the most common immunofluorescent patterns being homogeneous (39%), speckled (20%), mixed (17%), nucleolar (8%), Ro (7%) and centromere (4%). Ro antibody as detected by immunofluorescence was strongly concordant with anti-Ro detected by counter immunoelectrophoresis precipitation; of 261 anti-Ro counter immunoelectrophoresis precipitation positive patients surveyed, only 15 were missed and 20 masked (with homogenous pattern) by immunofluorescence. Ro antibodies were found in patients with a variety of immune disorders, particularly connective tissue disorders, whilst a clinical survey of the anticentromere sera revealed that 67% were derived from patients with limited scleroderma. Extractable nuclear antibodies and their characterization was performed on 10 939 occasions with 12.9% being positive with anti-Ro constituting 30.2%, anti-Ro/La 25.7%, unidentified precipitin line 17.8%, anti-ribo nuclear protein 12.5%, respectively, with anti-Scl70, anti-Jo-1 and anti-Sm and various combinations making up the remainder. Unidentified precipitin lines were particular prominent in patients with connective tissue disorders. DNA quantification was performed on 12 068 occasions with 11% giving elevated values, the majority from patients with systemic lupus erythematosus. Of these positive sera 44% also demonstrated one or more extractable nuclear antibodies and 25% anticardiolipin antibodies. Regular participation in a Quality Assurance Program revealed accurate and consistent performance of antinuclear antibody testing. In conclusion antinuclear antibody detection and characterization for systemic immune disorders can provide the clinician with useful diagnostic and prognostic information; it is important that the laboratory results are relevant, timely, accurate and precise. Systematic reviews as demonstrated in this report, can provide such evidence.
对一个为40万人口服务的地区免疫治疗实验室6年间的抗核抗体检测进行了系统评价。在对转染了高表达Ro的细胞底物进行的20205次抗核抗体检测中，28%呈阳性（滴度≥1:80），最常见的免疫荧光模式为均质型（39%）、斑点型（20%）、混合型（17%）、核仁型（8%）、Ro型（7%）和着丝粒型（4%）。免疫荧光检测到的Ro抗体与对流免疫电泳沉淀法检测到的抗Ro高度一致；在接受调查的261例对流免疫电泳沉淀法抗Ro阳性患者中，免疫荧光法仅漏检15例，20例被掩盖（均质型模式）。Ro抗体在各种免疫疾病患者中均有发现，尤其是结缔组织疾病患者，而对着丝粒血清的临床调查显示，67%来自局限性硬皮病患者。进行了10939次可提取核抗体及其特征分析，12.9%呈阳性，其中抗Ro占30.2%，抗Ro/La占25.7%，未鉴定沉淀线占17.8%，抗核糖核蛋白占12.5%，其余为抗Scl70、抗Jo-1、抗Sm及各种组合。未鉴定沉淀线在结缔组织疾病患者中尤为突出。进行了12068次DNA定量检测，11%结果值升高，大多数来自系统性红斑狼疮患者。在这些阳性血清中，44%还显示一种或多种可提取核抗体，25%显示抗心磷脂抗体。定期参与质量保证计划显示抗核抗体检测性能准确且一致。总之，系统性免疫疾病的抗核抗体检测和特征分析可为临床医生提供有用的诊断和预后信息；实验室结果相关、及时、准确和精确非常重要。如本报告所示，系统评价可提供此类证据。
