Department of Microbiology, Immunology and Transplantation, KU Leuven and Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.
Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium.
Nat Rev Rheumatol. 2020 Dec;16(12):715-726. doi: 10.1038/s41584-020-00522-w. Epub 2020 Nov 5.
Antinuclear antibodies (ANAs) are valuable laboratory markers to screen for and support the diagnosis of various rheumatic diseases (known as ANA-associated rheumatic diseases). The importance of ANA testing has been reinforced by the inclusion of ANA positivity as an entry criterion in the 2019 systemic lupus erythematosus classification criteria. In addition, specific ANAs (such as antibodies to Sm, double-stranded DNA (dsDNA), SSA/Ro60, U1RNP, topoisomerase I, centromere protein B (CENPB), RNA polymerase III and Jo1) are included in classification criteria for other rheumatic diseases. A number of techniques are available for detecting antibodies to a selection of clinically relevant antigens (such as indirect immunofluorescence and solid phase assays). In this Review, we discuss the advantages and limitations of these techniques, as well as the clinical relevance of the differences between the techniques, to provide guidance in understanding and interpreting ANA test results. Such understanding not only necessitates insight into the sensitivity and specificity of each assay, but also into the importance of the disease context and antibody level. We also highlight the value of titre-specific information (such as likelihood ratios).
抗核抗体 (ANA) 是筛选和支持各种风湿性疾病（称为 ANA 相关风湿性疾病）诊断的有价值的实验室标志物。ANA 检测的重要性得到了加强，因为 2019 年系统性红斑狼疮分类标准将 ANA 阳性作为纳入标准。此外，特定的 ANA（如抗 Sm、双链 DNA（dsDNA）、SSA/Ro60、U1RNP、拓扑异构酶 I、着丝粒蛋白 B（CENPB）、RNA 聚合酶 III 和 Jo1 抗体）被纳入其他风湿性疾病的分类标准。有多种技术可用于检测对一系列临床相关抗原的抗体（如间接免疫荧光和固相测定）。在这篇综述中，我们讨论了这些技术的优缺点，以及技术之间差异的临床相关性，以提供理解和解释 ANA 检测结果的指导。这种理解不仅需要深入了解每个检测的敏感性和特异性，还需要了解疾病背景和抗体水平的重要性。我们还强调了滴度特异性信息（如似然比）的价值。
