(บทความวิจัย) การเปรียบเทียบการตรวจ anti-dsDNA ด้วยวิธี Crithidia luciliae Immunofluorescence Test และ Line Immunoblot Assay ในการวินิจฉัยโรค SLE และ Lupus Nephritis

Wisansanee Karoonboonyanan; Kittikorn  Duangkum; Pimchanok  Tantiwong; Manasita  Tanya; Yada  Siriphannon; Teerasak  Phajan

Authors

Wisansanee Karoonboonyanan Department of Medical Technology and Clinical Pathology, Khon Kaen Hospital, Khon Kaen Province, Thailand
Kittikorn Duangkum Division of Rheumatology, Department of Internal Medicine, Khon Kaen Hospital, Khon Kaen Province, Thailand
Pimchanok Tantiwong Division of Rheumatology, Department of Internal Medicine, Khon Kaen Hospital, Khon Kaen Province, Thailand
Manasita Tanya Division of Rheumatology, Department of Pediatrics, Khon Kaen Hospital, Khon Kaen Province, Thailand
Yada Siriphannon Division of Rheumatology, Department of Internal Medicine, Khon Kaen Hospital, Khon Kaen Province, Thailand
Teerasak Phajan Sirindhorn College of Public Health Khon Kaen, Faculty of Public Health and Allied Health Sciences, Praboromarajchanok Institute, Khon Kaen Province, Thailand

Keywords:

Line immunoblot assay, Crithidia luciliae immunofluorescence test, Lupus nephritis, Systemic lupus erythematosus disease, Anti-double-stranded DNA

Abstract

Anti-dsDNA is an important immunologic criterion for diagnosing SLE. Crithidia luciliae immunofluorescence test (CLIFT) and line immunoblot assay (LIA) detect anti-dsDNA by relying on different antigens and principles. This study evaluated the concordance between the two methods, and studied the final diagnosis when they disagreed, with consideration of whether anti-nucleosome and anti-histone were relevant. Laboratory results of Khon Kaen Hospital patients were retrieved for those suspected of SLE and whose anti-dsDNA tests were run for both CLIFT and via LIA, from 2018 to 2023. 1,799 cases in total. Of these cases, 300 cases where the results of both tests either disagreed or did not fully agree were checked for diagnosis in medical records and were analyzed using Cohen’s kappa, descriptive statistics and Chi-square or Fisher’s exact test. From total 1,799 cases, there was moderate agreement between the two methods (kappa = 0.548). From 1,436 cases with LIA-negative anti-dsDNA, detection of anti-nucleosome or anti-histone was significantly related to anti-dsDNA detection by CLIFT (p < 0.001) with moderate chance. However, if anti-dsDNA CLIFT was known positive (211 cases), detection of the two antibodies did not help identify SLE or lupus nephritis (LN) better (p = 0.967 and 0.247 respectively). When CLIFT and LIA disagreed, CLIFT identified SLE and LN significantly better (p < 0.001). Examining results of each method when the other was known positive showed that CLIFT identified SLE (p < 0.001) and LN (p = 0.048) well, while LIA did not (p = 0.748 and 0.095 respectively). In conclusions, when anti-dsDNA is negative in LIA test, the presence of anti-nucleosome or anti-histone implies moderate chance of positive anti-dsDNA if tested with CLIFT. And positive anti-dsDNA CLIFT result can then identify SLE and LN better. However, if anti-dsDNA CLIFT is known positive, further LIA test for anti-dsDNA, anti-nucleosome and anti-histone is not necessary for SLE diagnosis. This approach may optimize diagnostic efficiency, reduce healthcare costs, and shorten time to diagnosis.

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