新型药物治疗背景下重症肌无力自身抗体检测的变化。

IF 2.5 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY
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引用次数: 0

摘要

获得性肌无力(MG)是一种针对突触后肌膜上特定蛋白质的自身免疫性疾病。50%的眼型 MG 和 80% 的全身型 MG 都有乙酰胆碱受体抗体(AChR 抗体)。1%-10%的MG患者有肌肉特异性激酶(MuSK)抗体,2%-50%血清阴性的MG病例有脂蛋白受体相关蛋白4抗体(LRP4 Abs)。血清学检测对于诊断 MG 患者并确定适当的治疗方法至关重要。放射免疫沉淀法(RIPA)是检测 AChR Abs 和 MuSK Abs 的历史性标准检测方法。虽然该方法在检测 AChR Abs 方面的特异性接近 100%,但其灵敏度在 50%-92% 之间。RIPA 检测 MuSK Abs 的灵敏度和特异性要低得多。基于固定细胞和活细胞的检测方法(f-CBA 和 L-CBA)的灵敏度高于 RIPA。随着 MG 血清学诊断和管理的进步,我们现在建议对疑似 MG 患者的第一份预处理样本进行完整的反射检测算法,首先用 RIPA 和/或 f-CBA 对 AChR 抗体进行结合和阻断检测。如果 AChR 抗体为阴性,则通过 RIPA 和/或 CBA 对 MuSK 抗体进行检测。如果 AChR 和 MuSK 抗体均为阴性,则根据要求使用聚类 L-CBA。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The changing landscape of autoantibody testing in myasthenia gravis in the setting of novel drug treatments
Acquired myasthenia gravis (MG) is an autoimmune disease targeting the specific proteins in the postsynaptic muscle membrane. 50% of ocular and 80% of generalized MG have acetylcholine receptor antibodies (AChR Abs). 1–10% of MG patients have antibodies against muscle-specific kinase (MuSK), and 2–50 % of seronegative MG cases have antibodies against lipoprotein-receptor-related protein4 antibodies (LRP4 Abs). Serological testing is crucial for diagnosing and determining the appropriate therapeutic approach for MG patients. The radioimmunoprecipitation assay (RIPA) method is a historical standard test for detecting the AChR Abs and MuSK Abs. While it has nearly 100% specificity in the AChR Abs detection, its sensitivity is between 50––92%. The sensitivity and specificity of RIPA for detecting MuSK Abs is much lower. The fixed and live Cell-Based assays (f-CBA and L- CBA) have higher sensitivity than RIPA. With advancements in the serological diagnosis and management of MG, we now recommend a complete reflex testing algorithm on the first pretreatment sample of a suspected MG patient, starting with the binding and blocking assays for AChR Abs by RIPA and/ or f-CBA. If AChR Ab is negative, then reflex to MuSK Abs by RIPA and/ or CBAs. If AChR and MuSK Abs are negative, then use clustered L-CBA by request.
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来源期刊
Clinical biochemistry
Clinical biochemistry 医学-医学实验技术
CiteScore
5.10
自引率
0.00%
发文量
151
审稿时长
25 days
期刊介绍: Clinical Biochemistry publishes articles relating to clinical chemistry, molecular biology and genetics, therapeutic drug monitoring and toxicology, laboratory immunology and laboratory medicine in general, with the focus on analytical and clinical investigation of laboratory tests in humans used for diagnosis, prognosis, treatment and therapy, and monitoring of disease.
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