The University of Melbourne, Department of Medicine, Royal Melbourne Hospital, Parkville, VIC 3050, Australia.
The University of Melbourne, Department of Medicine, Royal Melbourne Hospital, Parkville, VIC 3050, Australia.
J Immunol Methods. 2018 Jul;458:1-7. doi: 10.1016/j.jim.2018.02.016. Epub 2018 Feb 24.
Testing for antineutrophil cytoplasmic antibodies (ANCA) is performed to diagnose or exclude small vessel vasculitis, and, in treated patients, to monitor disease activity. However testing is also undertaken to assist with the diagnosis of other autoimmune diseases and some infections. Most laboratories use the same assays for all sera regardless of the testing indications. The International Consensus Statement on ANCA Testing and Reporting recommended screening for ANCA by indirect immunofluorescence (IIF) and confirming IIF-positive sera in antigen-specific ELISAs for both proteinase 3 (PR3) and myeloperoxidase (MPO). These guidelines have been reviewed after many refinements of the assays, and the development of new testing methodologies. However the advances have focused largely on improving the diagnostic accuracy in new-onset vasculitis, and not on more accurately monitoring disease activity, nor increasing the diagnostic sensitivity for non-vasculitic conditions. The recently-revised guidelines for ANCA testing indicate that where new onset vasculitis is suspected, sera should be examined for both PR3- and MPO-ANCA using any highly sensitive and specific assay, rather than IIF. They further state that where sera are negative in one assay but the suspicion of vasculitis is high, that testing should be repeated using a different assay. The guidelines do not provide recommendations for treated vasculitis or non-vasculitic disease. However for a routine diagnostic laboratory where sera are tested for many different indications, or where the reasons are not known, IIF screening followed by confirmation of IIF-positive sera in antigen-specific assays remains a highly sensitive, specific and convenient method for detecting ANCA in "all-comers".
检测抗中性粒细胞胞浆抗体（ANCA）用于诊断或排除小血管血管炎，并且在治疗患者中用于监测疾病活动。然而，检测也用于协助诊断其他自身免疫性疾病和一些感染。大多数实验室使用相同的检测方法检测所有血清，而不考虑检测指征。《抗中性粒细胞胞浆抗体检测和报告的国际共识声明》建议通过间接免疫荧光（IIF）进行 ANCA 筛查，并在蛋白酶 3（PR3）和髓过氧化物酶（MPO）的抗原特异性 ELISA 中确认 IIF 阳性血清。这些指南在经过多次检测方法的改进和新检测方法的开发后进行了回顾。然而，这些进展主要集中在提高新发病血管炎的诊断准确性上，而不是更准确地监测疾病活动，也没有提高非血管炎疾病的诊断敏感性。最近修订的 ANCA 检测指南指出，在怀疑新发血管炎时，应使用任何高灵敏度和特异性的检测方法检测血清中的 PR3-和 MPO-ANCA，而不是 IIF。它们进一步指出，在一种检测方法中血清为阴性，但血管炎的怀疑很高时，应使用不同的检测方法重复检测。该指南未为治疗性血管炎或非血管炎疾病提供建议。然而，对于一个常规的诊断实验室，其中血清用于检测许多不同的指征，或者原因未知，那么 IIF 筛查后在抗原特异性检测中确认 IIF 阳性血清仍然是一种高度敏感、特异和方便的方法，用于检测“所有患者”中的 ANCA。
