Not all anti-parietal cell antibody tests are equal for diagnosing pernicious anemia.

IF 3.7 2区 医学 Q1 MEDICAL LABORATORY TECHNOLOGY
Valentin Lacombe, Geoffrey Urbanski
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引用次数: 0

Abstract

Objectives: Pernicious anemia (PA) is a common cause of vitamin B12 deficiency and requires a robust diagnosis to guide lifelong treatment. Anti-parietal cell antibodies (APCA) are frequently used as a diagnostic marker, but their poor specificity raises concerns about overdiagnosis, particularly in patients lacking the more specific but less sensitive anti-intrinsic factor antibodies (IFA). We compared the diagnostic performance of two APCA detection methods: indirect immunofluorescence (IIF) and immunodot assay.

Methods: We prospectively enrolled patients with B12 deficiency and APCA positivity without IFA. PA diagnosis was adjudicated by blinded expert based on histology and response to oral B12. Patients were classified as true PA (APCA-PA), false positive (APCA-FP), or undetermined. Only APCA-PA and APCA-FP cases were analyzed.

Results: Among 56 included patients, 19 were classified as APCA-PA and compared to 24 APCA-FP. APCA immunodot assay was positive in 19/19 APCA-PA vs. 23/24 APCA-FP (p>0.99), while APCA IIF was positive in 13/19 APCA-PA vs. 2/24 APCA-FP (p<0.001), with higher IIF titers among APCA-PA (p<0.001). Only IIF positivity was significantly associated with PA (68.4 % vs. 8.3 %, p<0.001), with 92 % specificity. This association was confirmed in multivariate analysis (OR 37.1 [95 % CI: 6.1-439.4]). APCA IIF titer was also associated with PA diagnosis (AUC 0.82 [95 % CI: 0.68-0.96]), and titer ≥1:80 further improved specificity to 96 %.

Conclusions: IIF is more specific than immunodot for PA diagnosis, and its result should prevail over immunodot when deciding whether to perform EGD, when EGD is not feasible, and when establishing the diagnosis if biopsies are inconclusive.

并不是所有的抗壁细胞抗体测试都能诊断恶性贫血。
目的:恶性贫血(PA)是维生素B12缺乏症的常见原因,需要强有力的诊断来指导终身治疗。抗壁细胞抗体(APCA)经常被用作诊断标记,但其特异性较差引起了对过度诊断的担忧,特别是在缺乏更特异性但不太敏感的抗内在因子抗体(IFA)的患者中。比较了间接免疫荧光法(IIF)和免疫点法两种APCA检测方法的诊断性能。方法:前瞻性纳入B12缺乏症和APCA阳性的非IFA患者。PA的诊断是由盲法专家根据组织学和口服B12的反应来判断的。将患者分为真PA (APCA-PA)、假阳性(APCA-FP)或不确定。仅分析APCA-PA和APCA-FP病例。结果:56例患者中,19例为APCA-PA, 24例为APCA-FP。APCA免疫点检测在19/19 APCA-PA和23/24 APCA- fp中呈阳性(p < 0.99),而APCA IIF在13/19 APCA-PA和2/24 APCA- fp中呈阳性(p < 0.99)。结论:IIF对PA的诊断比免疫点更具特异性,在决定是否行EGD时,当EGD不可行时,当活检不确定时建立诊断时,其结果应优于免疫点。
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来源期刊
Clinical chemistry and laboratory medicine
Clinical chemistry and laboratory medicine 医学-医学实验技术
CiteScore
11.30
自引率
16.20%
发文量
306
审稿时长
3 months
期刊介绍: Clinical Chemistry and Laboratory Medicine (CCLM) publishes articles on novel teaching and training methods applicable to laboratory medicine. CCLM welcomes contributions on the progress in fundamental and applied research and cutting-edge clinical laboratory medicine. It is one of the leading journals in the field, with an impact factor over 3. CCLM is issued monthly, and it is published in print and electronically. CCLM is the official journal of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) and publishes regularly EFLM recommendations and news. CCLM is the official journal of the National Societies from Austria (ÖGLMKC); Belgium (RBSLM); Germany (DGKL); Hungary (MLDT); Ireland (ACBI); Italy (SIBioC); Portugal (SPML); and Slovenia (SZKK); and it is affiliated to AACB (Australia) and SFBC (France). Topics: - clinical biochemistry - clinical genomics and molecular biology - clinical haematology and coagulation - clinical immunology and autoimmunity - clinical microbiology - drug monitoring and analysis - evaluation of diagnostic biomarkers - disease-oriented topics (cardiovascular disease, cancer diagnostics, diabetes) - new reagents, instrumentation and technologies - new methodologies - reference materials and methods - reference values and decision limits - quality and safety in laboratory medicine - translational laboratory medicine - clinical metrology Follow @cclm_degruyter on Twitter!
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