鉴于ANA测定与SLE分类的相关性日益增加,以及围绕不同ANA测定性能的不确定性和变化,我们在当地队列中比较了人上皮2型(HEp-2)和小鼠肝脏(ML)底物,并对其用于自身免疫性风湿性疾病(ARDs)的证据进行了综述.
电子健康记录数据(2003-2008)用于识别并发HEp-2和MLANA的患者,并诊断为SLE或其他ARD。我们确定了HEp-2和MLANA之间关于积极性的协议,滴度和模式,和他们的预测因素。HEp-2ANA的敏感性,MLANA,重复HEp-2ANA,并结合HEp-2和MLANA测定进行评估。
有961例患者并发HEp-2和MLANA样本,包括418条。在HEp-2和MLANA(κ(κ)=0.35-0.79)中通常有相当到中等的一致性,滴度(κ=0.34-0.79)和模式(κ=0.35-0.93)。在SLE中,抗dsDNA抗体的存在可以预测HEp-2和MLANA之间的ANA一致性(校正OR6.27,95%CI1.45~27.20,p=0.01).当重复HEp-2测试时,大多数ARD的ANA敏感性最高,然后是HEp-2和MLANA组合以及仅使用HEp-2或MLANA。
与之前的研究一致,我们证明,在HEp-2和ML作为各种ARD中ANA检测底物的最大比较中,HEp-2和ML测定之间存在相当至中等的一致性.此外,当重复HEp-2测定而不是组合HEp-2和ML时,ANA灵敏度更高。
Given the increasing relevance of the ANA assay to classification of SLE and the uncertainty and variation surrounding different ANA assay performance, we compared the human epithelial type 2 (HEp-2) to mouse liver (ML) substrate in our local cohort and provided a
review of the evidence for their use in autoimmune rheumatic diseases (ARDs).
Electronic health record data (2003-2008) were used to identify patients who had concurrent HEp-2 and ML ANA, and a diagnosis of SLE or other ARDs. We determined the agreement between HEp-2 and ML ANA regarding positivity, titre and pattern, and their predictors. Sensitivity of HEp-2 ANA, ML ANA, repeating HEp-2 ANA, and combining HEp-2 and ML ANA assays was assessed.
There were 961 patients with concurrent HEp-2 and ML ANA samples, including 418 SLEs. There was generally fair to moderate agreement in HEp-2 and ML ANA (kappa (κ)=0.35-0.79), titres (κ=0.34-0.79) and patterns (κ=0.35-0.93). In SLE, the presence of anti-dsDNA antibodies was predictive of ANA agreement between HEp-2 and ML ANA (adjusted OR 6.27, 95% CI 1.45 to 27.20, p=0.01). The ANA sensitivity for most ARDs was highest when the HEp-2 test was repeated, followed by when the HEp-2 and ML ANA were combined and when only the HEp-2 or ML ANAs were used.
In keeping with prior studies, we demonstrated that there was fair to moderate agreement between HEp-2 and ML assays in the largest comparison of HEp-2 and ML as substrates for ANA testing in various ARDs. Furthermore, ANA sensitivity was higher when the HEp-2 assay was repeated rather than combining HEp-2 and ML.