自體免疫檢測選項

醫療照護人員會根據患者可能罹患的特定疾病進行實驗室檢測，以協助診斷自體免疫疾病。

通常包括針對一種或多種自體抗體的血液檢測，以及針對發炎反應的檢測，如C 反應 ... Areyouahealthcareprofessional? Theinformationinthiswebsiteisintendedonlyforhealthcareprofessionals.Byenteringthissite,youareconfirmingthatyouareahealthcareprofessional. EnterSite ✕ Areyoualaboratoryprofessional? Theinformationinthiswebsiteisintendedonlyforlaboratoryprofessionals.Byenteringthissite,youareconfirmingthatyouarealaboratoryprofessional. EnterSite ✕ Allergy AllergyOverview RespiratoryAllergies RespiratoryAllergiesOverview AllergicRhinitis IndoorAllergies FoodAllergies FoodAllergiesOverview Cow'sMilkAllergy EggAllergy PeanutAllergy TreeNutAllergy FishAllergy ShellfishAllergy WheatAllergy SoyAllergy AtopicDermatitis Urticaria PetAllergy VenomAllergy DrugAllergy LatexAllergy ChronicOtitisMedia Mastocytosis Asthma AutoimmuneDisease AutoimmuneDiseaseOverview AntiphospholipidSyndrome ConnectiveTissueDiseases GastrointestinalDiseases RheumatoidArthritis AutoimmuneThyroidDisease Vasculitis HowtoTest HowtoTestOverview AllergyTestingOptions AutoimmunityTestingOptions ResourceCenter AllergenEncyclopedia ContactUs Home HowtoTest AutoimmunityTestingOptions AutoimmunityTestingOptions Autoantibodiescanbespecificmarkersforautoimmune(AI)diseasesandareakeycomponentinthediagnosisofdiseaseswhichareoftenunderestimatedanddifficulttodetermine. CriteriaandTestsfor AutoimmuneDiseaseDiagnosis Laboratorytestsperformedtoaidinthediagnosisofautoimmunedisordersdependontheparticulardisorder(s)thehealthcareprovidersuspectsapatienthas,butusuallyincludebloodtestsforoneormoreautoantibodiesaswellastestsforinflammationsuchasC-reactiveproteinlevels(CRP)andelevatederythrocytesedimentationrate(ESR). Bloodtestingoptions   AntiphospholipidSyndrome   ExploreAntiphospholipidSyndromeLaboratoryTesting Accordingtointernationalclassificationcriteria,identificationofAPSrequiresthepresenceofvascularthrombosisand/orpregnancymorbidity,alongwithatleastoneofthefollowingantiphospholipidantibodytests,whichareoftenperformedinparallel:1 LupusAnticoagulant(LA) CardiolipinIgGand/orIgMantibodies β2-glycoproteinI(β2-GPI)IgGand/orIgMantibodies1 ConnectiveTissueDisease   ExploreConnectiveTissueDiseaseLaboratoryTesting Sjögren’ssyndrome Accordingtothe2016AmericanCollegeofRheumatology/EuropeanLeagueAgainstRheumatismclassificationcriteriaforprimarySjögren’ssyndrome,individualswithsignsand/orsymptomssuggestiveofSjögren’ssyndromewhohaveatotalscoreof≥4fortheitemsbelowmeetthecriteriaforprimarySjögren’ssyndrome:2 Anti-SSA/Roantibodypositivityandfocallymphocyticsialadenitiswithafocusscoreof≥1foci/4 mm3,eachscoring3 AnabnormalOcularStainingScoreof≥5(orvanBijsterveldscoreof≥4) ASchirmer’stestresultof≤5 mm/5 min Anunstimulatedsalivaryflowrateof≤0.1 mL/min,eachscoring1 Systemiclupuserythematosus(SLE) Accordingtothe1997Updateofthe1982AmericanCollegeofRheumatologyRevisedCriteriaforDiagnosisofSLE,fourof11followingcriteriashouldbefulfilledatthesametimeorinsuccession:4 Malarrash Discoidrash Photosensitivity Oralulcers Non-erosivearthritis Pleuritisorpericarditis Renaldisorder(proteinuria>0.5g/dayorcellularcasts) Neurologicdisorder Hematologicdisorder Immunologicdisorder(anti-DNA/anti-Sm/LEcell/false-positiveSTS APositiveANA:AnabnormaltitreofantinuclearantibodybyimmunofluorescenceORanequivalentassayatanypointintimeand(intheabsenceofdrugs)   Systemicsclerosis Accordingtothe2013ACR/EULARclassificationcriteriaforSystemicSclerosis,patientswithatotalscoreof≥9areclassifiedashavingdefiniteSSc.5 Items Sub-items Score SkinthickeningofthefingersofbothhandsextendingproximaltotheMCPjoints(sufficientcriteria) -- 9 Skinthickeningofthefingers (onlycountthehighestscore) Puffyfingers Sclerodactylyofthefingers 2 4 Fingertiplesions (onlycountthehighestscore) Digitaltipulcers Fingertippittingscars 2 3 Telangiectasia -- 2 Abnormalnailfoldcapillaries -- 2 Pulmonaryarterialhypertensionand/orinterstitiallungdisease (maximumscoreis2) Pulmonaryarterialhypertension Interstitiallungdisease 2 2 Raynaud'sphenomenon -- 3 SSc-relatedantibodies Anti-centromere Anti-Scl-70 Anti-RNApolymeraseIII 3 -- --     Polymyositis/Dermatomyositis Accordingtothe2017EULAR/ACRclassificationcriteriaforadultandjuvenileIdiopathicInflammatoryMyopathies(IMM)andtheirmajorsubgroups,includingpolymyositis/dermatomyositis,patientswithprobabilityabove55percent,whennobetterexplanationforthesymptomsorsignsexists,areclassifiedashavingIIM.6 Items NoBiopsy Biopsy Ageofonsetoffirstrelatedsymptoms 18-40age≥40age 1.3 2.1 1.5 2.2 Muscleweakness Objectivesymmetricweakness,usuallyprogressive,ofproximalupperextremities Objectivesymmetricweakness,usuallyprogressive,ofproximallowerextremities Neckflexorsarerelativelyweakerthanneckextensors Inthelegs,proximalmusclesarerelativelyweakerthandistalmuscles 0.7 0.8 1.9 0.9 0.7 0.5 1.6 1.2 SkinManifestations Heliotroperash Gottron'spapules Gottron'ssign 3.1 2.1 3.3 3.2 2.7 3.7 Otherclinicalmanifestations Dysphagiaoresphagealdysmotility 0.7 0.6 Laboratorymeasurements Anti-Jo1autoantibodypositivity Elevatedserumlevel(aboveuppelimitofnormal)ofcreatinekinaseorlactatedehydrogenaseoraspartateaminotransferaseoralanineaminotransferase 3.9 1.3 3.8 1.4 Musclebiopsyfeatures Endomysialinfiltrationofmononuclearcellssurrounding,butnotinvading,myofibres Perimysialand/orperivascularinfiltrationofmononuclearcells Perifascicularatrophy Rimmedvacuoles -- -- -- -- 1.7 1.2 1.9 3.1 Mixedconnectivetissuedisease(MCTD) ThereisoverlappingdiagnosticcriteriaforMCTDs.AcomparisonstudydeterminedthatMCTDwasbestidentifiedwiththeAlarcón-SegoviacriteriaandtheKahncriteria.7 TheAlarcón-Segoviadiagnosticcriteria: Serologicalcriteriaandatleastthreeclinicalcriteria. Iftheclinicalcriteria1,4,and5arepresent,then2or3arerequiredaswell. Serologicalcriteria: Apositiveanti-RNPatahemagglutinationtiterof1:1600orhigherANDatleastthreeofthefollowingfiveclinicalcriteria: Edemaofthehands Synovitis Myositis Raynaud’sphenomenon Acrosclerosis TheKahndiagnosticcriteria: Serologicalcriteriaandclinicalcriteria.1 Atleasttwooftheotherclinicalcriteria. Serologicalcriteria: Ahightiterofanti-RNPcorrespondingtospeckledANAattiter1:2000orhigher. Clinicalcriteria: Raynaud’sphenomenon Synovitis Myositis Swollenfinger CeliacDisease   ExploreCeliacDiseaseLaboratoryTesting Serologicaltestingcanhelpdifferentiatethisdiseaseandprovideanaccurate,expediteddiagnosis.Itmayhelptoconsidertestingwhenthereispresentationofgastrointestinal(GI)symptomsoranewdiagnosisforaconditionthatincreasestheriskforhavingCD.8 Internationalclassificationcriteriaadvocatesforserologictestingtohelpaidinthediagnosisofceliacdisease.TheEuropeanSocietyforPediatricGastroenterology,HepatologyandNutritionhaspublishedguidelinesforthediagnosisofceliacdiseaseforchildrenoradolescentswithotherwiseunexplainedsymptomsandsignssuggestiveofCD.9 Itstatesthatchildrenshouldbetestedfor: ImmunoglobulinA(IgA)Transglutaminase(tTG)andtotalIgA,asthefirstchoice DeamidatedGliadin(DGP-AGA)IgG,tTGIgG,orIgGEndomysialAntibodies(EMA)ifIgAisdeficient IntheUK,theNationalInstituteforHealthandCareExcellenceencouragesyoungpeopleandadultstobetestedfor:10 tTGIgAandtotalIgAasthefirstchoice IgAEMAiftTGIgAisweaklypositive IgGdeamidatedgliadinpeptide,tTGIgG,orIgGEMAifIgAisdeficient TheAmericanCollegeofGastroenterologyrecommendsthatadultsinwhomceliacdiseaseissuspectedbytestingaccordingtothefollowingalgorithms.3   × SpecificLaboratoryTestingforCeliacDisease tTGIgAtests&IgGtest-|DGPIgGtest- Unlikely Follow-upwithdifferentialdiagnosis Diagnosis:CeliacDiseaselesslikely × SpecificLaboratoryTestingforCeliacDisease tTGIgA+(<10xcutoff*)0-3additionalseriologicaltests+ Likely Follow-upwithbiopsy Results+ Results- Diagnosis:CeliacDisease Follow-upwithdifferentialdiagnosis Therapy:Gluten-freeDiet × SpecificLaboratoryTestingforCeliacDisease tTGIgA++(>10xcutoff*)0-3additionalseriologicaltests+ Verylikely Diagnosis:CeliacDisease Therapy:Gluten-freeDiet × SpecificLaboratoryTestingforCeliacDisease tTGIgAtests-|tTGIgGtest+|DGPIgGtest+ Possible CheckTotalIgA IgAdeficiency   NoIgAdeficiency Follow-upwithbiopsy Unlikely Results+   Results-   Follow-upwithdifferentialdiagnosis Diagnosis: CeliacDisease   Unlikely   Diagnosis: CeliacDiseaselesslikely Therapy:Gluten-freediet   Follow-upwithdifferentialdiagnosis Diagnóstico:DoençaCelíaca  Diagnosis:Celiacdiseaselessikely AdaptedfromHusby,etal2012,Werkstetteretal.,2017,andWorldHealthOrganization,2015.Pleasebeawarethatadditionalanalyticalparameterscanbenecessary. Crohn’sDisease   ExploreCrohn’sDiseaseLaboratoryTesting TestingtodifferentiateCrohn’sDisease(CrD)fromUlcerativeColitis(UC),bothmainIBDentities,canhelpyouchoosethemostappropriatetherapyforyourpatient.11Anti-SaccharomycesCerevisiaeAntibodies(ASCA)testing,incombinationwithPerinuclearAntineutrophilCytoplasmicAutoantibodies(pANCA),maybeusedtoaidindifferentialdiagnosisofCrDandUC,especiallyinIBD-unclassified(IBD-U)patients.12,13InmanyIBD-Upatients,pathologymakesendoscopicdifferentiationextremelydifficult.14,15 ThecombinationofpositivepANCAwithnegativeASCAisindicativeforUC,whereasthecombinationofpositiveASCAwithnegativepANCAisindicativeforCrohn´sdisease.16 UsingASCAandpANCAtohelpdifferentiateCrohn’sdiseaseandulcerativecolitis:16   × SerologicalMarkersofInflammatoryBowelDisease ReccurentGISymptoms Clinicianrequestsdiagnostictestsasdeterminedbyhistory Seriologicalmarkers,bloodcountandfecalcalprotectin FecalCalprotectin +Result IBDmorelikely ASCAIgA IgGpANCA ASCA+ pANCA - ASCA- pANCA + CrDmorelikely UCmorelikely     ReccurentGISymptoms Clinicianrequestsdiagnostictestsasdeterminedbyhistory Seriologicalmarkers,bloodcountandfecalcalprotectin FecalCalprotectin -Result FBDmorelikely(includingIBS) ThyroidDiseases   ExploreThyroidDiseasesLaboratoryTesting ThefollowingalgorithmsmaybehelpfulindiagnosingAITDs,i.e.,autoimmunethyroiditisorHashimoto’sthyroiditisandGraves’disease.Gettingthesepatientstheappropriatediagnosisisveryimportant.ThepresenceofAITDs,especiallyHashimoto’sthyroiditis,increasestheriskforotherautoimmunediseasessuchasType1diabetesmellitusandAddison’sdisease.17,18Beawareofthislinkandconsidertestingyourpatientforotherautoimmunediseases,ifappropriate.   × ThyroidDisordersIndicationforTesting Clinic:Normalthyroidfunction(euthyroidism)orhypothyroidism TSHincreased(>4.5mlU/L);T3andT4usuallydecreased Sonography:struma,diffusehypoechogenicity(lowechodensity) TPOAntibodies:70-90%positive (TGAntibodies:35-60%positive) SuggestedDiagnosis: Auotimmunethyroiditis(Hashimoto'sthyroiditisorpossiblyatrophicform) × ThyroidDisordersIndicationforTesting Clinic:Hyperthyroidism(possible:endocrineorbitopathy)   TSHdecreased(<0.01mlU/L);T3andT4usuallyincreased Sonography:struma,diffusehypoechogenicity,increasedbloodcirculation TSH-Rantibodies:upto100%positive (TPOantibodies:45-80%; TGantibodies:~30%) SuggestedDiagnosis: Graves'Disease   RheumatoidArthritis   ExploreRheumatoidArthritisLaboratoryTesting NumerousinternationalguidelinesrecommendRFIgMandanti-CCPasfirst-lineteststoaidinthediagnosisofrheumatoidarthritis.CCPantibodiesappearintheearlystagesofrheumatoiddisease.19,20 Internationalguidelinesclassificationcriteriaalsorecommendlaboratorytestingfor: ErythrocyteSedimentationRate(ESR) C-ReactiveProtein(CRP) Manytestsmeasurerheumatoidfactor(RF)usingnephelometryorturbidometry.However,usinganRApanelthatcandistinguishbetweenthedifferentRFisotypes—RFIgAandRFIgMinparticular—cangiveyouimportantadditionaldiagnosticguidance.21-23 Vasculitis   ExploreVasculitisLaboratoryTesting InternationalguidelinesrecommendpositiveserologyforANCAs.Thesediagnostictoolscanhelpyouidentifythediseaseandstartyourpatientsontheroadtotreatmentforgranulomatosiswithpolyangiitis(GPA),microscopicpolyangiitis(MPA),andeosinophilicgranulomatosiswithpolyangiitis(EGPA).24 Therevised2017internationalconsensusontestingofANCAsinGPAandMPAproposesthathigh-qualityimmunoassaysforMPOandPR3antibodiesshouldbeusedastheprimaryscreeningmethodforpatientssuspectedofhavingtheANCA-associatedvaculitidesGPAandMPAwithouttheneedforindirectimmunofluorescence(IIF).24 References MiyakisS,LockshinMD,AtsumiT,etal.Internationalconsensusstatementonanupdateoftheclassificationcriteriafordefiniteantiphospholipidsyndrome(APS).JThrombHaemost. 2006;4(2):295-306. ShiboskiCH,ShiboskiSC,SerorR,etal.2016AmericanCollegeofRheumatology/EuropeanLeagueAgainstRheumatismClassificationCriteriaforPrimarySjogren’sSyndrome. AnnRheumDis.2017;76(1):9-16. GaubitzM. Epidemiologyofconnectivetissuedisorders. Rheumatology (Oxford). 2006;45(Suppl3):iii3-4. AmericanCollegeofRheumatology.1997Updateofthe1982ACRCriteriafortheClassificationofSLE. http://www.rheumatology.org/Portals/0/Files/1997%20Update%20of%201982%20Revised.pdf.AccessedDecember2017. vandenHoogenF.ClassificationCriteriaforSystemicSclerosis:AnACR-EULARCollaborativeInitiative ArthritisRheum.2013;65(11):2737-2747. BottaiM,TjärnlundA,SantoniG,etal.EULAR/ACRClassificationcriteriaforadultandjuvenileidiopathicinflammatorymyopathiesandtheirmajorsubgroups:amethodologyreport. RMDOpen 2017;3:e000507. JMAmigues,ACantagrel,MAbbal,etal.Comparativestudyof4diagnosiscriteriasetsformixedconnectivetissuediseaseinpatientswithanti-RNPantibodies.AutoimmunityGroupoftheHospitalsofToulouse. JofRheum.1997;(23)2055-62. Rubio-TapiaA,HillID,KellyCP,etal.ACGClinicalGuidelines:DiagnosisandManagementofCeliacDisease. AmJGastroenterol. 2013;108:656-676. HusbyS,KoletzkoS,Korponay-SzabóIR,etal. EuropeanSocietyforPediatricGastroenterology, Hepatology,andNutritionGuidelinesfortheDiagnosisofCoeliacDisease.JPediatr Gastroenterol Nutr. 2012;54:136-160. NationalInstituteforHealthandCareExcellence.Coeliacdisease:recognition,assessmentandmanagement.https://www.nice.org.uk/guidance/ng20/resources/coeliac-disease-recognition-assessment-and-management-pdf-1837325178565.AccessedNovember2017. KovácsM,MüllerKE,PappM,etal.Newserologicalmarkersinpediatricpatientswithinflammatoryboweldisease.WorldJGastroenterol.2014;20(17):4873-4882. LevineA,KoletzkoS,TurnerD,etal.ESPGHANRevisedPortoCriteriafortheDiagnosisofInflammatoryBowelDiseaseinChildrenandadolescents.JPediatrGastroenterolNutr.14;58:795-806.  JoossensS,ReinischW,VermeireS,etal.Thevalueofserologicmarkersinindeterminatecolitis:aprospectivefollow-upstudy.Gastroenterology.2002;122:1242-1247.  BurakoffR.Indeterminatecolitis:clinicalspectrumofdisease.JClinGastroenterol.2004;38(5Suppl1):S41-S43.  BousvarosA,AntonioliDA,CollettiRB,etal.DifferentiatingulcerativecolitisfromCrohndiseaseinchildrenandyoungadults:reportofaworkinggroupoftheNorthAmericanSocietyforPediatricGastroenterology,Hepatology,andNutritionandtheCrohn’sandColitisFoundationofAmerica.JPediatrGastroenterolNutr.2007;44(5):653-674.  BossuytX.Serologicmarkersininflammatoryboweldisease.ClinChem.2006;52:2:171-181. IddahMA,MachariaBN.Autoimmunethyroiddisorders. ISRNEndocrinol. 2013;2013:509764. BoelaertK, NewbyPR, SimmondsMJ,etal.PrevalenceandRelativeRiskofOtherAutoimmuneDiseasesinSubjectswithAutoimmuneThyroidDisease.AmJMed.2010;123(2):183.e1-9. SchellekensGA, VisserH, deJongBA, etal.Thediagnosticpropertiesofrheumatoidarthritisantibodiesrecognizingacycliccitrullinatedpeptide;ArthritisRheum. 2000;43(1):155-163. BerglinE,PadyukovL,SundinU,etal.Acombinationofautoantibodiestocycliccitrullinatedpeptide(CCP)andHLA-DRB1locusantigensisstronglyassociatedwithfutureonsetofrheumatoidarthritis.ArthritisResTher.2004;6(4):R303-R308. Bobbio-PallaviciniF,CaporaliR,AlpiniC,etal.HighIgArheumatoidfactorlevelsareassociatedwithpoorclinicalresponsetotumournecrosisfactorαinhibitorsinrheumatoidarthritis.AnnRheumDis.2007;66(3):302-307. JónssonT,ValdimarssonH.Ismeasurementofrheumatoidfactorisotypesclinicallyuseful?AnnRheumDis.1993;52(2):161-164. ShakibaY,KoopahS,JamshidiAR,etal.Anti-cycliccitrullinatedpeptideantibodyandrheumatoidfactorisotypesinIranianpatientswithrheumatoidarthritis:evaluationofclinicalvalueandassociationwithdiseaseactivity.IranJAllergyAsthmaImmunol.2014;13(3):147-156. BossuytX,CohenTervaertJ-W,ArimuraY,etal.Revised2017internationalconsensusontestingofANCAsingranulomatosiswithpolyangiitisandmicroscopicpolyangiitis.NatureRevRheumatol.2017;doi:10.1038/nrrheum.2017.140