■在使用HEp-2细胞间接免疫荧光测定(HEp-2-IFA)进行自身抗体测试的日常实验室常规中,模式的组合是常见且具有挑战性的情况。最近,巴西自身抗体共识(BCA)将这些组合命名为复杂模式(CP),并将它们组织成3个亚型:多个,混合,和复合材料。本研究旨在根据该新命名法描述HEp-2-IIF模式的最常见组合。
■使用新的BCA分类审查了2017年1月和6月报告的常规HEp-2-IFA结果。由专家对HEp-2-IFA读数进行视觉模式识别,使用国际抗核抗体共识(ANA)模式(ICAP)和BCA建议。
■对来自不同患者的54,990份血清样本进行了ANA-HEp-2检测,滴度≥1/80时11,478份(20.9%)为阳性。在这些阳性样本中,1,111(9.7%)显示CP,分为95种不同的组合。在儿科年龄组中观察到较高比例的CP。多个,混合,和复合图案存在于85.3、5.4和9.5%的样品中,分别。在多重/混合模式组中(n=1,005),双,三重,在97.7%中观察到四重组合(ICAP/BCA代码),2.2%,和0.1%,分别。双核模式是观察到的最普遍的组合(67.6%)。最常见的注册CP是AC-4(核细小斑点)AC-6,7(核离散点)(n=264);AC-2(核致密细斑点)AC-6,7(n=201);AC-4AC-8,9,10(核仁)(n=129);和AC-3(着丝粒)AC-4(n=124)。所有这些组合都在多个亚组中。
■在HEp-2程序中几乎有10%的阳性结果显示了CP。在提出的3种CP亚型中,多重模式是最普遍的,尤其是在儿科人群中。AC-4、AC-2和AC-6,7是在本研究中描述的组合中观察到的最普遍的单一模式。年龄与大多数合并模式的患病率之间存在显着关联。AC-4+AC-6,7组合是检测到的最普遍的复杂模式,与年龄组无关。AC-2+AC-6,7在年轻人中更为普遍。CPs定义中涉及的概念应该为HEp-2-IIF测定的阅读和解释增加价值。
The combination of patterns is a frequent and challenging situation in the daily laboratory routine of autoantibodies testing using HEp-2 cells indirect immunofluorescence assay (HEp-2-IFA). Recently, the Brazilian Consensus on Autoantibodies (BCA) named these combinations as complex patterns (CPs) and organized them into 3 subtypes: multiple, mixed, and composite. This study aimed to describe the most frequent combinations of HEp-2-IIF patterns according to this new nomenclature.
Routine HEp-2-IFA results reported in January and June 2017 were reviewed using the new BCA classification. Visual pattern recognition was performed by experts on HEp-2-IFA readings, using the International Consensus on Antinuclear Antibodies (ANA) Patterns (ICAP) and BCA recommendations.
54,990 serum samples from different patients were tested for ANA-HEp-2, and 11,478 (20.9%) were positive at a titer ≥ 1/80. Among these positive samples, 1,111 (9.7%) displayed CPs, divided into 95 different combinations. A higher proportion of CPs was observed in the pediatric age group. Multiple, mixed, and composite patterns were present in 85.3, 5.4, and 9.5% of the samples, respectively. In the multiple/mixed pattern group (n=1,005), double, triple, and quadruple combinations (ICAP/BCA codes) were observed in 97.7%, 2.2%, and 0.1%, respectively. The double nuclear pattern was the most prevalent combination observed (67.6%). The most common CPs registered were AC-4 (nuclear fine speckled) + AC-6,7 (nuclear discrete dots) (n=264); AC-2 (nuclear dense fine speckled) + AC-6,7 (n=201); AC-4+AC-8,9,10 (nucleolar) (n=129); and AC-3 (centromere)+AC-4 (n=124). All of these combinations were in the multiple subgroup.
Almost 10% of positive results in the HEp-2 procedure displayed CPs. Among the 3 subtypes of CPs proposed, the multiple pattern was the most prevalent, especially in the pediatric population. The AC-4, AC-2, and AC-6,7 were the most prevalent single patterns observed in the combinations described in this study. There was a significant association between age and the prevalence of most combined patterns. The AC-4+AC-6,7 combination was the most prevalent complex pattern detected regardless of the age group. The AC-2+AC-6,7 was more prevalent in younger individuals. The concepts involved in the CPs definition should add value to the reading and interpretation of the HEp-2-IIF assay.