Anis Sabiha, Fatima Areej, Abdul Jabbar Sidra, Arain Tayyab
Department of Pathology and Department of Medicine and Allied, The Indus Hospital and Health Network (IHHN), Karachi, Pakistan.
Department of Pathology, The Indus Hospital and Health Network (IHHN), Karachi, Pakistan.
Immunol Res. 2023 Apr;71(2):267-275. doi: 10.1007/s12026-022-09347-z. Epub 2022 Dec 2.
The diagnosis of systemic autoimmune diseases (SAID) is challenging, due to overlapping features with other non-immune disorders. Anti-nuclear antibodies (ANA)/anti-cellular antibodies are the sensitive screening tests but anti-double-stranded-deoxyribonucleic acid-antibody (anti-ds-DNA) and ANA-specific antibodies are specific for SAID. We aimed to look at ANA-specific antibodies in our patients and correlated them with ANA patterns, anti-ds-DNA, and clinical diagnosis for proper interpretation and better patient management cost-effectively. A retrospective data analysis of 641 patients was done (1st of February 2019 to 31st of July 2021) who were tested for ANA-specific antibodies at the Immunology Department of Indus Hospital and Health Network. ANA and anti-ds-DNA results and clinical diagnosis were also analyzed for ANA-specific antibody-positive patients. Descriptive data were presented in mean ± standard deviation and frequency percentages whereas inferential data were analyzed with a chi-square test for association between ANA-specific antibodies status, ANA, anti-ds-DNA, and clinical features. ANA-specific antibodies test revealed positivity for at least one autoantibody in 245 (38.2%) patients. Of these, ANA was tested in 206 patients reactive for ANA-specific antibodies and found positive in 195 (95%) as compared to negative (< 0.001). Speckled and homogenous were predominant ANA patterns in ANA-specific antibody-positives (56% and 42% respectively). Multiple ANA patterns were found in 18 patients most commonly with systemic lupus erythematosus (SLE) and mixed connective tissue disorder (MCTD). Anti-SSA were the most common ANA-specific antibodies (50%) and were mostly found in sera with speckled (61/97) and homogenous (38/97) patterns and associated mostly with SLE (48%) and Sjogren's syndrome (86%). Among ANA-negative patients, anti-SSA were the most common antibodies (n = 5). Anti-ds-DNA was found in 66% of SLE patients along with another ANA-specific antibody. This study showed that testing for ANA-specific antibodies cannot be gated on ANA patterns. Also, there is a redundancy of these antibodies with various clinical diagnoses. Moreover, they are useful in making a diagnosis in ANA-negative patients as well with clinical suspicion.
由于与其他非免疫性疾病存在重叠特征，系统性自身免疫性疾病（SAID）的诊断具有挑战性。抗核抗体（ANA）/抗细胞抗体是敏感的筛查试验，但抗双链脱氧核糖核酸抗体（抗ds-DNA）和ANA特异性抗体对SAID具有特异性。我们旨在研究我们患者中的ANA特异性抗体，并将它们与ANA模式、抗ds-DNA和临床诊断相关联，以便进行合理的解读并以具有成本效益的方式更好地管理患者。对641例患者（2019年2月1日至2021年7月31日）进行了回顾性数据分析，这些患者在印度河医院和健康网络免疫科接受了ANA特异性抗体检测。还对ANA特异性抗体阳性患者的ANA和抗ds-DNA结果以及临床诊断进行了分析。描述性数据以均值±标准差和频率百分比呈现，而推断性数据则通过卡方检验分析ANA特异性抗体状态、ANA、抗ds-DNA和临床特征之间的关联。ANA特异性抗体检测显示245例（38.2%）患者中至少有一种自身抗体呈阳性。其中，对206例对ANA特异性抗体呈反应性的患者进行了ANA检测，发现195例（95%）呈阳性，而阴性的比例<0.001。斑点型和均质型是ANA特异性抗体阳性患者中占主导的ANA模式（分别为56%和42%）。在18例患者中发现了多种ANA模式，最常见于系统性红斑狼疮（SLE）和混合性结缔组织病（MCTD）。抗SSA是最常见的ANA特异性抗体（50%），大多出现在斑点型（61/97）和均质型（38/97）模式的血清中，主要与SLE（48%）和干燥综合征（86%）相关。在ANA阴性患者中，抗SSA是最常见的抗体（n = 5）。66%的SLE患者同时还存在另一种ANA特异性抗体和抗ds-DNA。这项研究表明，不能根据ANA模式来决定是否检测ANA特异性抗体。此外，这些抗体在各种临床诊断中存在冗余。而且，它们在对临床有怀疑的ANA阴性患者的诊断中也很有用。
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