抗核抗体检测：临床效用研究

Antinuclear antibody testing. A study of clinical utility.

作者信息

Slater C A, Davis R B, Shmerling R H

机构信息

Division of Rheumatology, Beth Israel Hospital, Boston, Mass, USA.

出版信息

Arch Intern Med. 1996 Jul 8;156(13):1421-5.

PMID:8678710

Abstract

OBJECTIVE

To determine the clinical utility of the antinuclear antibody (ANA) test as ordered in a large teaching hospital.

METHODS

Retrospective chart review in a 400-bed teaching hospital that provides care for hospital-based and community-based practices.

PATIENTS

A consecutive sample of 1010 patients (including inpatients and outpatients) for whom ANA testing was ordered over 10 months; all patients with positive ANA test results and an equal number of randomly selected patients with negative test results were included. Clinical utility of the ANA in the identification of rheumatic disease was determined by its estimated sensitivity, specificity, and positive and negative predictive values.

RESULTS

Of 1010 ANA test results reviewed, 153 were positive. The group with positive ANA test results included more patients aged 65 years or older than the group with negative ANA test results (30% vs 15%, P < .003). The diagnosis of systemic lupus erythematosus (SLE) was established in 17 patients, all of whom had positive ANA test results. Other rheumatic diseases were found in an additional 22 patients. The estimated sensitivity and specificity of the ANA test for SLE were 100% and 86%, respectively. For other rheumatic diseases, sensitivity and specificity were 42% and 85%, respectively. The positive predictive value of the ANA test was 11% for SLE and 11% for other rheumatic diseases. Specificity and positive predictive value for ANA testing in the elderly patients were lower than among younger patients.

CONCLUSIONS

The sensitivity of the ANA test for SLE was high, but overall the positive predictive value was low for SLE or other rheumatic diseases. Sensitivity was low for ANA testing among patients with non-SLE rheumatic disease. More selective test ordering might improve the clinical utility of this test. Clinicians ordering the ANA test should be aware of the test's low-positive predictive value in settings with a low prevalence of rheumatic disease, particularly among older patients.

摘要

目的

确定在一家大型教学医院中按医嘱进行抗核抗体（ANA）检测的临床效用。

方法

在一家拥有400张床位的教学医院进行回顾性病历审查，该医院为住院患者和社区患者提供医疗服务。

患者

连续抽取10个月内接受ANA检测的1010例患者（包括住院患者和门诊患者）；纳入所有ANA检测结果呈阳性的患者以及数量相等的随机选择的检测结果呈阴性的患者。通过估计ANA在识别风湿性疾病方面的敏感性、特异性、阳性预测值和阴性预测值来确定其临床效用。

结果

在审查的1010份ANA检测结果中，153份呈阳性。ANA检测结果呈阳性的组中65岁及以上的患者比ANA检测结果呈阴性的组更多（30%对15%，P <.003）。17例患者被确诊为系统性红斑狼疮（SLE），所有这些患者的ANA检测结果均为阳性。另外22例患者被发现患有其他风湿性疾病。ANA检测对SLE的估计敏感性和特异性分别为100%和86%。对于其他风湿性疾病，敏感性和特异性分别为42%和85%。ANA检测对SLE的阳性预测值为11%，对其他风湿性疾病的阳性预测值为11%。老年患者ANA检测的特异性和阳性预测值低于年轻患者。