Tonutti Elio, Visentini Daniela, Bizzaro Nicola
Laboratorio di Immunopatologia e Allergologia, Azienda Ospedaliera S. Maria della Misericordia, P.zzale S. Maria della Misericordia, 33100 Udine, Italy.
Autoimmun Rev. 2007 Jun;6(6):341-6. doi: 10.1016/j.autrev.2007.01.007. Epub 2007 Jan 29.
Immunology laboratories perform diagnostic tests to identify the autoantibody markers needed to classify disorders which are complex, often rare, and hard to define. The recent introduction of new markers and the use of increasingly complicated assay procedures can cause difficulty in interpreting test results. Moreover, during the performance of some tests, some autoantibodies which were not requested, and consequently not expected, may be identified by chance. It is advisable for these positive results to be reported only when they have a high predictive value and suggest the possible presence of an autoimmune disease. An interpretative comment on autoantibody test results is crucial in a number of cases: when autoantibodies with a significant clinical correlation (high specificity) are found; when two or more methods are used to determine the same autoantibody and the results disagree; when unexpected autoantibody positivity is found and in case of results generated by further diagnostic tests conducted by the laboratory on its own initiative. The interpretative comment should be based on the patient's personal characteristics (sex, age) and the other laboratory parameters available; it should specify the diagnostic accuracy of the assay methods used, the clinical and diagnostic correlations of the antibodies which tested positive, and any further tests needed to complete the diagnostic process.
免疫学实验室进行诊断测试，以识别对复杂、通常罕见且难以定义的疾病进行分类所需的自身抗体标志物。新标志物的近期引入以及日益复杂的检测程序的使用可能会导致测试结果解释困难。此外，在某些测试过程中，可能会偶然发现一些未被要求检测因而也未被预期的自身抗体。仅当这些阳性结果具有高预测价值并提示可能存在自身免疫性疾病时，才建议报告这些结果。在许多情况下，对自身抗体测试结果进行解释性说明至关重要：当发现具有显著临床相关性（高特异性）的自身抗体时；当使用两种或更多方法检测同一自身抗体且结果不一致时；当发现意外的自身抗体阳性时，以及在实验室主动进行的进一步诊断测试产生结果的情况下。解释性说明应基于患者的个人特征（性别、年龄）以及其他可用的实验室参数；应指明所使用检测方法的诊断准确性、检测为阳性的抗体的临床和诊断相关性，以及完成诊断过程所需的任何进一步测试。
