Lee Adrian Y S, Hudspeth Andrew R, Adelstein Stephen
Western Health, Melbourne, Vic, Australia; School of Medicine, University of Tasmania, Hobart, Tas, Australia; Royal Hobart Hospital, Hobart, Tas, Australia.
Royal Hobart Hospital, Hobart, Tas, Australia.
Pathology. 2016 Oct;48(6):597-601. doi: 10.1016/j.pathol.2016.06.003. Epub 2016 Sep 3.
The antinuclear antibody (ANA) tests are some of the more frequently requested tests for the diagnosis of autoimmunity. Although they are used primarily as diagnostic blood tests, multiple requests on the same patient continue to be encountered in the laboratory. This retrospective analysis of serial ANA testing at one pathology laboratory in Australia is the first study that examines the statistical concordance and possible implications of this on clinical practice. High-titred ANA have quite good repeatability for titre and pattern, and low-titred ANA, which can be non-specific, have poor repeatability. Staining patterns are, in general, almost random in nature on serial tests when compared to the first-obtained ANA pattern for each patient. This study confirms that there is little benefit in serial ANA testing, and only if there is a clear change in the patient's clinical picture would repeat of an initial low-titred ANA be useful. The findings reinforce the need for pathology stewardship to minimise costs, wasted resources and unnecessary referrals.
抗核抗体（ANA）检测是诊断自身免疫性疾病时最常被要求进行的检测项目之一。尽管它们主要用作诊断性血液检测，但实验室中仍不断遇到对同一患者进行多次检测的情况。这项对澳大利亚一家病理实验室连续ANA检测的回顾性分析，是第一项研究其统计一致性及其对临床实践可能影响的研究。高滴度ANA在滴度和模式方面具有相当好的重复性，而低滴度ANA可能是非特异性的，重复性较差。与每位患者首次获得的ANA模式相比，连续检测时染色模式总体上几乎是随机的。本研究证实，连续ANA检测几乎没有益处，只有在患者临床表现有明显变化时，重复进行最初的低滴度ANA检测才有用。这些发现强化了病理管理的必要性，以尽量减少成本、资源浪费和不必要的转诊。
