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001-es BibID:	BIBFORM075565
Első szerző:	Nagy Gábor (laboratóriumi szakorvos, laboratóriumi hematológus és immunológus)
Cím:	Diagnostic algorithm for antinuclear antibody testing : clinical and financial considerations / G. Nagy, I. Csípő, E. Gyimesi, J. Tóth, S. Demeter, P. Antal-Szalmás
Dátum:	2018
Megjegyzések:	The diagnostics of autoimmune rheumatic diseases strongly depends on laboratory tests, dominantly on autoantibody determinations. Several techniques and assay types are available for evaluation of the autoantibody profile of these patients. The most widely used indirect immunofluorescence (IIF) assay on HEp-2 cells can identify dozens of antinuclear (ANA) and anti-cytoplasmic autoantibodies, while ELISA-s or immunoblots utilizing mixed or single antigens can identify the exact specificity of them. Since the application (replacement and sequential order) of these tests is rather ambiguous we developed an algorithm for the most frequently used antinuclear and anti-cytoplasmic autoantibodies and evaluated clinical and financial efficacy of this novel system. The number and results of autoantibody determinations (ANA HEp-2 IIF, anti-dsDNA and anti-ENA tests) between January and June, 2017 were collected from our laboratory information system (GLIMS). The theoretical number of autoantibody tests was recalculated along the following rule: anti-dsDNA and anti-ENA tests were performed only if ANA HEp-2 IIF was positive. Separate analyses were performed taking into account the ANA HEp-2 IIF patterns and titers, too. Our results showed that the ANA HEp-2 IIF guided selection of anti-dsDNA and anti-ENA ELISAs could reduce the number of anti-dsDNA and anti-ENA tests by 48% and 56%, sparing about 7.1M HUF per year. The rate of ANA HEp-2 IIF negative but anti-dsDNA positive cases was 1.8%, meaning 64 samples, from which 16 patients (0.45%) had significantly higher (>2x URL) anti-dsDNA value. The rate of ANA HEp-2 IIF negative but anti-ENA positive samples was 1.1% (56 cases). 14 and 19 of these patients showed only anti-SS-A or anti-Jo-1 positivity, known to be weakly reactive on HEp-2 cells. The described sequential application of ANA HEp-2 IIF assay, anti-dsDNA and anti-ENA ELISAs provided high clinical efficacy and proved to be cost-effective.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idézhető absztrakt
Megjelenés:	Clinical Chemistry and Laboratory Medicine. - 56 : 9 (2018), p. eA139-eA140. -
További szerzők:	Csípő István (1953-) (vegyész) Gyimesi Edit (1957-) (klinikai biokémikus, vegyész) Tóth Judit (1978-) (laboratóriumi szakorvos) Demeter S. Antal-Szalmás Péter (1968-) (laboratóriumi szakorvos)
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