液流芯片法在诊断抗中性粒细胞胞浆抗体相关性血管炎中的价值

doi:10.3969/j.issn.1673-8640.2019.07.014

摘要/Abstract

摘要：

目的探讨液流芯片法在诊断抗中性粒细胞胞浆抗体相关性血管炎（AAV）中的价值。方法选取AAV患者300例,非AAV自身免疫性疾病患者275例及健康对照者277名,分别采用线性免疫印迹法（LIA）和液相芯片法检测抗髓过氧化物酶（MPO）抗体和抗蛋白酶3（PR3）抗体,同时采用间接免疫荧光法（IFA）检测抗中性粒细胞胞浆抗体（ANCA）,比较不同检测方法的性能,并筛选诊断AAV的最佳检测方案。结果 LIA与液流芯片法检测抗MPO抗体、抗PR3抗体总阳性率较为一致,分别为83.1%、78.2%,kappa值均>0.75。液流芯片法的敏感性和特异性分别为85.7%、82.6%,均高于LIA的59.7%、56.6%（P<0.05）。胞浆型抗中性粒细胞胞浆抗体（cANCA）+抗PR3抗体、核周型抗中性粒细胞胞浆抗体（pANCA）+抗MPO抗体联合检测模式在AAV组中的阳性率最高,分别为42.4%、45.0%。结论液流芯片法对ANCA的检测有较高的敏感性和特异性,与IFA联合检测是诊断AAV的最佳方案。

关键词: 液流芯片法, 抗中性粒细胞胞浆抗体相关性血管炎, 免疫印迹法, 间接免疫荧光

Abstract:

Objective To investigate the role of multiplexed bead-based immunoassay in the determination of anti-neutrophil cytoplasmic antibody（ANCA）-associated vasculitis（AAV）. Methods A total of 300 patients with AAV,275 autoimmune disease patients without AAV and 277 healthy subjects（healthy control group） were enrolled. The roles of indirect immunofluorescence assay（IFA）,line immunoassay（LIA） and multiplexed bead-based immunoassay were evaluated by comparing the results of ANCA,anti-myeloperoxidase（MPO） antibody and anti-protease 3（PR3） antibody determinations. The optimal method for the determination of AAV was screened. Results There was no difference in the positive rate between LIA and multiplexed bead-based immunoassay by comparing the results of anti-MPO antibody and anti-PR3 antibody determinations. The positive rates were 83.1% and 78.2%,respectively,and the kappa value was >0.75. Multiplexed bead-based immunoassay showed higher sensitivity and specificity（85.7% and 82.6%） than those of LIA（59.7% and 56.6%）（P<0.05）. The models of cytoplasmic antineutrophil cytoplasmic antibody（cANCA）+PR3 and perinuclear antineutrophil cytoplasmic antibody（pANCA）+MPO showed higher positive rates in the diagnosis of AAV,and the positive rates were 42.4% and 45.0%,respectively. Conclusions Multiplexed bead-based immunoassay shows high sensitivity and specificity for ANCA determination,and the combined determination with IFA plays a role in the diagnosis of AAV.

Key words: Multiplexed bead-based immunoassay, Anti-neutrophil cytoplasmic antibody-associated vasculitis, Line immunoassay, Indirect immunofluorescence assay

中图分类号:

R446.61

张程, 杨莹, 吴珊珊, 吕丹, 张婷婷. 液流芯片法在诊断抗中性粒细胞胞浆抗体相关性血管炎中的价值[J]. 检验医学, 2019, 34(7): 633-636.

ZHANG Cheng, YANG Ying, WU Shanshan, LÜ Dan, ZHANG Tingting. Role of multiplexed bead-based immunoassay in the determination of AAV[J]. Laboratory Medicine, 2019, 34(7): 633-636.

图/表 3

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LIA	液流芯片法
	抗PR3抗体			抗MPO抗体
	+	-	合计	+	-	合计
+	151	46	193	152	31	183
-	68	587	659	132	537	669
合计	219	633	852	284	568	852

LIA	液流芯片法
	抗PR3抗体			抗MPO抗体
	+	-	合计	+	-	合计
+	151	46	193	152	31	183
-	68	587	659	132	537	669
合计	219	633	852	284	568	852

组别	例数	LIA		液流芯片法
组别	例数	+	-	+	-
AAV组	300	184	116	251	49
非AAV组	275	124	151	42	233
合计	575	308	267	293	282

组别	例数	LIA		液流芯片法
组别	例数	+	-	+	-
AAV组	300	184	116	251	49
非AAV组	275	124	151	42	233
合计	575	308	267	293	282

组别	例数	cANCA	pANCA	抗PR3抗体	抗MPO抗体
AAV组	271	2.9（8/271）	3.3（9/271）	1.8（5/271）	2.2（6/271）
非AAV组	30	10.0（3/30）	6.7（2/30）	6.7（2/30）	10.0（3/30）
正常对照组	13	7.7（1/13）	7.7（1/13）	15.4（2/13）	15.4（2/13）
组别	cANCA+ 抗PR3抗体	pANCA+ 抗MPO抗体	cANCA+ 抗MPO抗体	pANCA+ 抗PR3抗体	抗MPO抗体+ 抗PR3抗体
AAV组	42.4（115/271）	45.0（122/271）	0.7（2/271）	0.7（2/271）	0.7（2/271）
非AAV组	16.7（5/30）^*	20.0（6/30）^*	10.0（3/30）	10.0（3/30）	10.0（3/30）
正常对照组	15.4（2/13）^*	15.4（2/13）^*	15.4（2/13）	7.7（1/13）	0.0（0/13）