Ouazzani Hamza, Fadili Hajar, Filali Halima, Zrara Abdelhamid, Bamou Youssef, El Bakkouri Jalila
Biology, Cheikh Khalifa Ibn Zayed Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR.
Cureus. 2025 Jun 10;17(6):e85723. doi: 10.7759/cureus.85723. eCollection 2025 Jun.
This retrospective study examined the relationship between anti-nuclear antibody (ANA) titers, immunofluorescence (IIF) patterns, demographic variables, and anti-extractable nuclear antigen (ENA) positivity in a cohort of 538 patients at Cheikh Khalifa Hospital. Among them, 409 of 538 patients (76%) were women, and 129 of 538 (24%) were men. ANA and 15 ENA specificities were assessed using indirect IIF on Hep-2/monkey liver substrates and immunoblot analysis with the ANA Profile 3 Plus DFS-70 kit (EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany). ANA staining patterns were classified based on ICAP guidelines as speckled (S-ANA), homogeneous (H-ANA), cytoplasmic (C-ANA), and nucleolar (N-ANA). Certain patterns are known to be associated with specific antibodies or clinical conditions; for example, S-ANA may suggest anti-Sm antibodies in systemic lupus erythematosus, while C-ANA is often linked to anti-mitochondrial or anti-Jo-1 antibodies, commonly seen in primary biliary cholangitis or antisynthetase syndrome, respectively. Chi-square analyses were used to identify key factors predictive of ENA positivity. ANA was detected in 326 of 538 patients (60%). Among those who were positive, most were S-ANA, observed in 161 of 326 patients (49%). The second most common pattern was H-ANA, found in 49 of 326 (15%). Anti-ENA antibodies were identified in 268 of 538 patients (50%), with Ro-52, SS-A, and Pm-Scl100 being the most commonly detected specificities. Moderate and higher ANA titers (≥1:320) showed a strong association with ENA positivity. Our analyses indicate that high ANA titers and specific patterns, particularly S-ANA and H-ANA, are associated with ENA positivity and may aid in the interpretation of ENA tests. We also found that C-ANA didn't show any predictive value for ENA positivity. In contrast, N-ANA did have some predictive value but less unequivocal relationships with some ENA antibodies. The study noted that more women and patients aged 40-60 showed positive anti-ENA results; however, these observations may be affected by the overrepresentation of these groups. Furthermore, 47 of 538 patients (9%) who tested negative for ANA were still found to be anti-ENA positive, highlighting discrepancies that can occur between detection methods. These findings underscore the importance of integrating ANA profiles with the patient's clinical context, including their medical history and examination findings, to enhance diagnostic precision. Moving forward, further studies with standardized assay procedures and prospective clinical follow-up would help refine the interpretation of serological results.
这项回顾性研究在谢赫·哈利法医院的538名患者队列中，考察了抗核抗体（ANA）滴度、免疫荧光（IIF）模式、人口统计学变量与抗可提取核抗原（ENA）阳性之间的关系。其中，538名患者中有409名（76%）为女性，129名（24%）为男性。使用间接免疫荧光法在人喉癌上皮细胞（Hep-2）/猴肝底物上评估ANA和15种ENA特异性，并使用ANA Profile 3 Plus DFS-70试剂盒（德国吕贝克欧蒙医学诊断有限公司）进行免疫印迹分析。ANA染色模式根据国际抗核抗体模式分类（ICAP）指南分为斑点型（S-ANA）、均质型（H-ANA）、胞质型（C-ANA）和核仁型（N-ANA）。已知某些模式与特定抗体或临床情况相关；例如，S-ANA可能提示系统性红斑狼疮中的抗Sm抗体，而C-ANA通常与抗线粒体或抗Jo-1抗体相关，分别常见于原发性胆汁性胆管炎或抗合成酶综合征。采用卡方分析来确定预测ENA阳性的关键因素。538名患者中有326名（60%）检测到ANA。在这些阳性患者中，大多数为S-ANA，326名患者中有161名（49%）。第二常见的模式是H-ANA，326名中有49名（15%）。538名患者中有268名（50%）检测到抗ENA抗体，其中Ro-52、SS-A和Pm-Scl10（0）是最常检测到的特异性抗体。中度及更高ANA滴度（≥1:320）与ENA阳性呈强关联。我们的分析表明，高ANA滴度和特定模式，特别是S-ANA和H-ANA，与ENA阳性相关，可能有助于ENA检测结果的解读。我们还发现C-ANA对ENA阳性没有任何预测价值。相比之下，N-ANA确实有一些预测价值，但与某些ENA抗体的关系不太明确。该研究指出，更多女性和40 - 60岁的患者抗ENA结果呈阳性；然而，这些观察结果可能受到这些人群占比过高的影响。此外，538名患者中有47名（9%）ANA检测为阴性，但仍被发现抗ENA阳性，这突出了检测方法之间可能出现的差异。这些发现强调了将ANA谱与患者的临床背景（包括病史和检查结果）相结合以提高诊断准确性的重要性。展望未来，采用标准化检测程序和前瞻性临床随访的进一步研究将有助于完善血清学结果的解读。
