Ramachandran Aishwarya, Kumar Kennedy, Sankaralingam Rajeswari, Chinnadurai Saranya, Chilukuri Balaji
Microbiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND.
Rheumatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND.
Cureus. 2023 Dec 6;15(12):e50049. doi: 10.7759/cureus.50049. eCollection 2023 Dec.
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease. Detection of antinuclear antibodies (ANAs) aids in the diagnosis of SLE. The indirect immunofluorescence (IIF) assay is often used a routine screening test for the detection of ANA. The pathogenic role and significance of various patterns produced in IIF is yet to be explored.
This study aimed to detect ANA patterns generated by IIF and correlate these patterns with specific antibodies detected by line immunoassay. We also investigated the significance of each ANA pattern and its association with specific serological SLE markers, such as complement molecules, anti-dsDNA, antiphospholipid antibody, and C-reactive protein (CRP), along with associations with direct Coombs test (DCT).
We conducted a retrospective study that included 204 patients newly diagnosed with SLE according to the European Alliance of Associations for Rheumatology/American College of Rheumatology (EULAR/ACR) criteria. The detection and pattern determination of ANA was performed by IIF using HEp-20-10. Furthermore, line immunoassay was performed, and the antibody profile of each sample was obtained. Other immunodiagnostic markers were analyzed, including C3, C4, anti-dsDNA, antiphospholipid antibodies (anti-cardiolipin antibodies, anti-beta-2-glycoprotein I, and lupus anticoagulant), CRP, and DCT.
Of the 204 samples, the most frequent ANA pattern observed was nucleus speckled (52.9%), followed by nucleus homogenous (27.5%), mixed (13.7%), and cytoplasm speckled (5.9%). The nucleus homogenous pattern showed the most pathogenic immune profile due to its close association with markers of disease activity, namely, high anti-dsDNA titer, low C3 level, and DCT positivity. Conclusion: This study showed that the most common pattern associated with SLE is nucleus speckled, followed by the nucleus homogenous pattern. Based on associations with specific serological markers, the nucleus homogenous pattern may be linked to a high disease activity in SLE.
系统性红斑狼疮（SLE）是一种多系统自身免疫性疾病。抗核抗体（ANA）的检测有助于SLE的诊断。间接免疫荧光（IIF）检测常被用作ANA检测的常规筛查试验。IIF产生的各种模式的致病作用和意义尚待探索。
本研究旨在检测IIF产生的ANA模式，并将这些模式与线性免疫分析检测到的特异性抗体相关联。我们还研究了每种ANA模式的意义及其与特定血清学SLE标志物的关联，如补体分子、抗双链DNA、抗磷脂抗体和C反应蛋白（CRP），以及与直接抗人球蛋白试验（DCT）的关联。
我们进行了一项回顾性研究，纳入了204例根据欧洲抗风湿病联盟/美国风湿病学会（EULAR/ACR）标准新诊断为SLE的患者。使用HEp-20-10通过IIF进行ANA的检测和模式确定。此外，进行了线性免疫分析，并获得了每个样本的抗体谱。分析了其他免疫诊断标志物，包括C3、C4、抗双链DNA、抗磷脂抗体（抗心磷脂抗体、抗β2糖蛋白I和狼疮抗凝物）、CRP和DCT。
在204个样本中，观察到最常见的ANA模式是核颗粒型（52.9%），其次是核均质型（27.5%）、混合型（13.7%）和胞质颗粒型（5.9%）。核均质型模式显示出最具致病性的免疫特征，因为它与疾病活动标志物密切相关，即高抗双链DNA滴度、低C3水平和DCT阳性。
本研究表明，与SLE相关的最常见模式是核颗粒型，其次是核均质型。基于与特定血清学标志物的关联，核均质型模式可能与SLE的高疾病活动度相关。
