Muñoz-Sánchez Guillermo, Pérez-Isidro Albert, Ortiz de Landazuri Iñaki, López-Gómez Antonio, Bravo-Gallego Luz Yadira, Garcia-Ormaechea Milagros, Julià Maria Rosa, Viñas Odette, Ruiz-Ortiz Estíbaliz
Department of Immunology, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Villarroel 170-Escala 4, Planta 0, 08036 Barcelona, Spain.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain.
Diagnostics (Basel). 2022 Mar 12;12(3):697. doi: 10.3390/diagnostics12030697.
Autoantibody detection is the cornerstone of autoimmune liver diseases (AILD) diagnosis. Standardisation of working algorithms among autoimmunity laboratories, as well as being aware of the sensitivity and specificity of various commercial techniques in daily practice, are still necessary. The aim of this nationwide study is to report the results of the 2020 Autoimmunity Workshop organised by the Autoimmunity Group of the Spanish Society of Immunology and to provide useful information to clinicians and laboratory specialists to improve the management of autoantibody detection in AILD diagnoses. Serum samples from 17 patients with liver diseases were provided by the organisers of the 2020 Autoimmunity Workshop and were subsequently analysed by the 40 participating laboratories. Each laboratory used different techniques for the detection of autoantibodies in each patients’ serum sample, according to their working algorithm. Thus, almost 680 total complete patient reports were obtained, and the number of results from different autoantibody detection techniques was >3000. Up to eight different working algorithms were employed, including indirect immunofluorescence assays (IFA) and antigen-specific techniques (AgST). The IFA of HEp-2 cells was more sensitive than IFA of rat triple tissue for the study of anti-nuclear autoantibodies (ANA) associated with AILD. The IFA of a human neutrophil study for the analysis of anti-neutrophil cytoplasmic autoantibodies was not carried out systemically in all patients, or by all laboratories. AgSTs were the most sensitive methods for the detection of anti-smooth muscle/F-actin, soluble liver antigen, liver cytosol-1, M2-mitochondrial autoantibodies, and ANA associated with primary biliary cholangitis. The main differences in AMA detection were due to patients with autoantibodies against the non-dominant epitope of pyruvate dehydrogenase complex. Given that they are complementary, IFA and AgST should be performed in parallel. If there is high suspicion of AILD, AgST should always be performed.
自身抗体检测是自身免疫性肝病（AILD）诊断的基石。自身免疫实验室工作算法的标准化，以及在日常实践中了解各种商业技术的敏感性和特异性，仍然很有必要。这项全国性研究的目的是报告由西班牙免疫学会自身免疫小组组织的2020年自身免疫研讨会的结果，并为临床医生和实验室专家提供有用信息，以改善AILD诊断中自身抗体检测的管理。2020年自身免疫研讨会的组织者提供了17例肝病患者的血清样本，随后由40个参与实验室进行分析。每个实验室根据其工作算法，使用不同技术检测每个患者血清样本中的自身抗体。因此，总共获得了近680份完整的患者报告，不同自身抗体检测技术的结果数量超过3000份。采用了多达八种不同的工作算法，包括间接免疫荧光法（IFA）和抗原特异性技术（AgST）。对于与AILD相关的抗核自身抗体（ANA）研究，HEp-2细胞的IFA比大鼠三重组织的IFA更敏感。并非所有患者或所有实验室都系统地进行了用于分析抗中性粒细胞胞浆自身抗体的人中性粒细胞研究的IFA。AgST是检测抗平滑肌/F-肌动蛋白、可溶性肝抗原、肝细胞溶质-1、M2-线粒体自身抗体以及与原发性胆汁性胆管炎相关的ANA的最敏感方法。AMA检测的主要差异在于针对丙酮酸脱氢酶复合物非优势表位的自身抗体患者。鉴于IFA和AgST具有互补性，应并行进行。如果高度怀疑AILD，应始终进行AgST检测。
