Immunology Division, Sabin Medicina and Health, Brasília, Brazil.
Long-term Care Unit, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil.
Front Immunol. 2024 Jan 12;14:1256526. doi: 10.3389/fimmu.2023.1256526. eCollection 2023.
The combination of patterns is a frequent and challenging situation in the daily laboratory routine of autoantibodies testing using HEp-2 cells indirect immunofluorescence assay (HEp-2-IFA). Recently, the Brazilian Consensus on Autoantibodies (BCA) named these combinations as complex patterns (CPs) and organized them into 3 subtypes: multiple, mixed, and composite. This study aimed to describe the most frequent combinations of HEp-2-IIF patterns according to this new nomenclature.
Routine HEp-2-IFA results reported in January and June 2017 were reviewed using the new BCA classification. Visual pattern recognition was performed by experts on HEp-2-IFA readings, using the International Consensus on Antinuclear Antibodies (ANA) Patterns (ICAP) and BCA recommendations.
54,990 serum samples from different patients were tested for ANA-HEp-2, and 11,478 (20.9%) were positive at a titer ≥ 1/80. Among these positive samples, 1,111 (9.7%) displayed CPs, divided into 95 different combinations. A higher proportion of CPs was observed in the pediatric age group. Multiple, mixed, and composite patterns were present in 85.3, 5.4, and 9.5% of the samples, respectively. In the multiple/mixed pattern group (n=1,005), double, triple, and quadruple combinations (ICAP/BCA codes) were observed in 97.7%, 2.2%, and 0.1%, respectively. The double nuclear pattern was the most prevalent combination observed (67.6%). The most common CPs registered were AC-4 (nuclear fine speckled) + AC-6,7 (nuclear discrete dots) (n=264); AC-2 (nuclear dense fine speckled) + AC-6,7 (n=201); AC-4+AC-8,9,10 (nucleolar) (n=129); and AC-3 (centromere)+AC-4 (n=124). All of these combinations were in the multiple subgroup.
Almost 10% of positive results in the HEp-2 procedure displayed CPs. Among the 3 subtypes of CPs proposed, the multiple pattern was the most prevalent, especially in the pediatric population. The AC-4, AC-2, and AC-6,7 were the most prevalent single patterns observed in the combinations described in this study. There was a significant association between age and the prevalence of most combined patterns. The AC-4+AC-6,7 combination was the most prevalent complex pattern detected regardless of the age group. The AC-2+AC-6,7 was more prevalent in younger individuals. The concepts involved in the CPs definition should add value to the reading and interpretation of the HEp-2-IIF assay.
在使用 HEp-2 细胞间接免疫荧光法（HEp-2-IFA）进行自身抗体检测的日常实验室工作中，模式组合是一种常见且具有挑战性的情况。最近，巴西自身抗体共识（BCA）将这些组合命名为复杂模式（CPs），并将它们分为 3 个亚型：多重、混合和复合。本研究旨在根据这一新命名法描述 HEp-2-IIF 模式中最常见的组合。
使用新的 BCA 分类回顾了 2017 年 1 月和 6 月报告的常规 HEp-2-IFA 结果。专家使用国际核抗体共识（ANA）模式（ICAP）和 BCA 建议对 HEp-2-IFA 读数进行视觉模式识别。
对来自不同患者的 54,990 份血清样本进行了抗核抗体-HEp-2 检测，11,478 份（20.9%）滴度≥1/80 为阳性。在这些阳性样本中，有 1,111 份（9.7%）显示 CPs，分为 95 种不同的组合。在儿科年龄组中观察到更高比例的 CPs。多、混和复合模式分别占样本的 85.3%、5.4%和 9.5%。在多/混模式组（n=1,005）中，双、三、四重组合（ICAP/BCA 码）分别观察到 97.7%、2.2%和 0.1%。最常见的组合是双核模式（67.6%）。登记的最常见 CPs 是 AC-4（核细点状）+AC-6,7（核离散点）（n=264）；AC-2（核密集细点状）+AC-6,7（n=201）；AC-4+AC-8,9,10（核仁）（n=129）；和 AC-3（着丝粒）+AC-4（n=124）。所有这些组合都属于多亚组。
HEp-2 程序中近 10%的阳性结果显示 CPs。在所提出的 3 种 CPs 亚型中，多重模式最为常见，尤其是在儿科人群中。在本研究中描述的组合中，最常见的单一模式是 AC-4、AC-2 和 AC-6,7。年龄与大多数联合模式的流行率之间存在显著关联。无论年龄组如何，AC-4+AC-6,7 复合模式都是最常见的复杂模式。CPs 定义中涉及的概念应该为 HEp-2-IIF 检测的阅读和解释增加价值。
