Hsiao Chao-Yang, Su Li-Jen, Yu Kuang-Hui, Chan Tien-Ming
Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, and Chang Gung University, Taoyuan, Taiwan; Department of Biomedical Sciences and Engineering, National Central University, Taiwan.
Department of Biomedical Sciences and Engineering, National Central University, Taiwan.
Clin Chim Acta. 2026 Jan 1;578:120521. doi: 10.1016/j.cca.2025.120521. Epub 2025 Aug 6.
The clinical significance of autoantibodies with the cytoplasmic discrete dots pattern in HEp-2 cell indirect immunofluorescence assay (HEp-2 IFA), now classified as the anti-cell 18 (AC-18) pattern by International Consensus on Antinuclear Antibodies Patterns (ICAP), varies across cohorts, and remained underexplored.
We conducted a cross-sectional study on patients who underwent antinuclear antibody (ANA) testing via HEp-2 IFA at the Chang Gung Memorial Health System in Taiwan between January 2019 and September 2021. Among 7429 ANA-positive cases, 77 exhibited the AC-18 pattern and underwent chart review. A propensity score (PS) matching analysis was subsequently conducted, in which 53 patients exhibiting an isolated AC-18 pattern were matched to 265 control subjects, selected from a pool of 31,143 ANA-negative individuals at a 1:5 ratio. Matching was based on age, sex, and comorbidities.
Among the 77 patients positive for AC-18 pattern, 14.3% had Sjögren disease (SjD), 11.7% had rheumatoid arthritis (RA), 5.2% had idiopathic inflammatory myopathy (IIM), and 3.9% had systemic lupus erythematosus (SLE). Specifically, 29.9% had various types of cancer. In PS matching model, the prevalence of SjD, IIM and cancer was significantly higher in patients with the AC-18 pattern compared to the control group, with odds ratios (OR) of 16.8 (95% CI 3.3, 85.7), 7.9 (95% CI 1.3, 48.4), and 4.8 (95% CI 2.3, 10.3), respectively.
Individuals with a positive ANA test showing the AC-18 pattern have a notably higher prevalence of cancer and autoimmune diseases compared to those with negative ANA results.
在人喉表皮样癌细胞（HEp-2）间接免疫荧光法（HEp-2 IFA）中呈现胞质离散点状模式的自身抗体，目前被国际抗核抗体模式共识（ICAP）归类为抗细胞18（AC-18）模式，其临床意义在不同队列中有所不同，且仍未得到充分研究。
我们对2019年1月至2021年9月期间在台湾长庚纪念医疗体系通过HEp-2 IFA进行抗核抗体（ANA）检测的患者进行了一项横断面研究。在7429例ANA阳性病例中，77例呈现AC-18模式，并进行了病历审查。随后进行了倾向评分（PS）匹配分析，其中53例呈现孤立AC-18模式的患者与265例对照受试者进行匹配，这些对照受试者从31143例ANA阴性个体中按1:5的比例选取。匹配基于年龄、性别和合并症。
在77例AC-18模式阳性的患者中，14.3%患有干燥综合征（SjD），11.7%患有类风湿关节炎（RA），5.2%患有特发性炎性肌病（IIM），3.9%患有系统性红斑狼疮（SLE）。具体而言，29.9%患有各种类型的癌症。在PS匹配模型中，与对照组相比，呈现AC-18模式的患者中SjD、IIM和癌症的患病率显著更高，优势比（OR）分别为16.8（95%置信区间3.3, 85.7）、7.9（95%置信区间1.3, 48.4）和4.8（95%置信区间2.3, 10.3）。
与ANA检测结果为阴性的个体相比，ANA检测呈阳性且显示AC-18模式的个体患癌症和自身免疫性疾病的患病率显著更高。
