摘要
目的探讨胞质型抗核抗体(ANA)对间接免疫荧光法(IFA)检测抗中性粒细胞胞质抗体(ANCA)的影响。方法收集2023年6—7月上海交通大学医学院附属仁济医院非ANCA相关性血管炎,且ANA荧光模型为胞质型的患者血清样本66例,其中胞质线性/肌动蛋白型(AC-15型)2例、胞质丝状/微管型(AC-16型)4例、胞质散点型(AC-18型)7例、胞质致密颗粒型(AC-19型)25例、胞质细颗粒型(AC-20型)13例、胞质网状/线粒体样型(AC-21型)15例。采用IFA检测ANCA。采用免疫印迹法检测抗可溶性核抗原(ENA)抗体谱和自身免疫性肝病(AILD)抗体谱。采用酶联免疫吸附试验(ELISA)检测抗双链DNA(dsDNA)抗体、抗核小体抗体和ANCA谱。结果66例胞质型ANA阳性样本中,有65例(98.5%)ANCA为阴性,1例(1.5%)为不典型胞质型抗中性粒细胞胞质抗体(cANCA),ANCA谱均为阴性。采用IFA检测66例胞质型ANA阳性样本的ANCA,乙醇固定基质片有42.4%(28/66)为ANCA阴性,有30.3%(20/66)为不典型ANCA,有22.7%(15/66)为核周型抗中性粒细胞胞质抗体(pANCA),有4.5%(3/66)为cANCA;甲醛固定基质片仅1例(1.5%)阳性。25例AC-19型阳性样本中,有24例(96%)乙醇固定基质片表现为阳性,其中12例(48.0%)为pANCA,11例(44.0%)为非典型ANCA,1例(4.0%)为不典型cANCA;合并抗核糖体P蛋白(Rib.P)抗体阳性时,pANCA的阳性率(64.7%)显著高于抗Rib.P抗体阴性时(12.5%)(P=0.02)。15例AC-21型阳性样本中,有6例(40.0%)乙醇固定基质片表现为阴性中,有6例(40.0%)为非典型ANCA,2例(13.3%)为cANCA,1例(6.7%)为pANCA。AC-15型、AC-16型、AC-18型和AC-20型阳性样本乙醇固定基质片表现均以阴性为主,表现为阳性的样本多合并抗ENA抗体谱阳性。结论采用IFA检测ANCA时,胞质型ANA对甲醛固定基质片的影响较小,对乙醇固定基质片的干扰多见于AC-19型和AC-21型。当AC-19型和AC-21型合并抗ENA抗体阳性时,可产生pANCA或非典型ANCA干扰。
Objective To investigate the influence of cytoplasmic antinuclear antibody(ANA)on indirect immunofluorescence assay(IFA)based antineutrophil cytoplasmic antibody(ANCA)determination.Methods Totally,66 patients with non-ANCA-associated vasculitis with ANA patterns of cytoplasmic fibrillar linear(AC-15,2 cases),cytoplasmic fibrillar filamentous(AC-16,4 cases),cytoplasmic discrete dots/GW body-like(AC-18,7 cases),cytoplasmic dense fine speckled(AC-19,25 cases),cytoplasmic fine speckled(AC-20,13 cases)and cytoplasmic reticular/AMA(AC-21,15 cases)were enrolled from Renji Hospital of Shanghai Jiao Tong University School of Medicine from June to July 2023.IFA was carried out for ANCA,western blot was carried out for anti-extractable nuclear antigen(ENA)antibody spectrum and anti-autoimmune liver disease(AILD)antibody spectrum,and enzyme-linked immunosorbent assay(ELISA)was used for anti-doublestranded DNA(dsDNA)antibody,anti-nucleosome antibody and ANCA spectrum.Results Among 66 cases of cytoplasmic ANA,98.5%(65/66)were ANCA negative,and 1 case(1.5%)of atypical cytoplasmic ANA(cANCA)was ANCA negative.In ethanol-fixed human neutrophils,42.4%(28/66)were negative,30.3%(20/66)were atypical ANCA,22.7%(15/66)were perinuclear ANCA(pANCA),and 4.5%(3/66)were cANCA.The positive rate of formalin fixed neutrophils was 1.5%(1/66).The 96%(24/25)of AC-19 samples were positive in ethanol-fixed substrate,48.0%(12/25)for pANCA,44.0%(11/25)for atypical ANCA,and 4.0%(1/25)for atypical cANCA.The positive rate of pANCA was higher when accompanied with anti-ribosomal P protein antibody than anti-ribosomal protein(Rib.P)antibody negative(64.7%,12.5%,P=0.02).AC-21 mainly showed as negative and atypical ANCA in ethanol-fixed substrate,whose percentages were both 40.0%(6/15),13.3%(2/15)for cANCA,and 6.7%(1/15)for pANCA.AC-15,AC-16,AC-18 and AC-20 were mainly negative in ethanol-fixed substrate,and most of the positive samples in ethanol-fixed substrate were positive when accompanied with anti-ENA antibody spectrum.Conclusions Cytoplasmic ANA has l
作者
杨晓
李恩灵
吴丽霞
戴颖欣
王之青
黄昊
郑冰
YANG Xiao;LI Enling;WU Lixia;DAI Yingxin;WANG Zhiqing;HUANG Hao;ZHENG Bing(Department of Clinical Laboratory,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)
出处
《检验医学》
CAS
2023年第12期1135-1140,共6页
Laboratory Medicine
基金
上海市扬帆计划资助项目(22YF1438400)
广东省钟南山基金资助项目(ZNSXS-20220007)。
关键词
抗核抗体
胞质型
抗中性粒细胞胞质抗体
干扰
Antinuclear antibody
Cytoplasmic type
Antineutrophil cytoplasmic antibody
Interference
