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心包积液是什么

  心包积液是一种较常见的临床表现尤其是在超声心动图成为心血管疾病的常规检查方式之后,心包积液在病人中的检出率明显上升,可高达8.4%大部分心包积液由于量少而不出现临床征象。少数病人则由于大量积液而以心包积液成为突出的临床表现。当心包积液持续数月以上时便构成慢性心包积液。导致慢性心包积液的病因有多种,大多与可累及心包的疾病有关。
  心包积液分析对心包疾病的诊断与治疗有重要的指导意义。同时,心包积液分析结果应结合临床症状及其他检查指标如血清学肿瘤标记物、自身抗体标记物与结核标记物进行综合评价。

心包积液分析
  心包积液分析能够建立病毒性、细菌性、结核性、真菌性、胆固醇性与恶性心包炎。心包积液分析结果也应与临床表现相结合。对怀疑恶性肿瘤的患者,应该检查细胞学与肿瘤标记物如癌胚抗原 (CEA),甲胎蛋白 (AFP), 糖链抗原CA 125、CA 72-4、CA15-3、CA 19-9、 CD-30、CD-25等。对怀疑结核性心包炎患者,应检查抗酸杆菌染色、分支杆菌培养、腺苷脱氨酶(ADA)、γ干扰素与结核的PCR检查。CEA增高,ADA(腺苷脱氨酶)降低可鉴别肿瘤与结核性心包积液。 此外,较高水平的ADA 对心包缩窄有预测价值。但是,必须认识到对结核诊断,PCR敏感性与ADA相似(75% vs 83%),但前者特异性更高(100% vs 78%)。对疑有细菌感染者,应同时做心包液与周身血液厌氧需氧菌培养3次。亲心脏病毒PCR分析可协助鉴别病毒性或自身免疫性心包炎。对心包积液的比重分析(>1015)、蛋白含量(>3.0 g/dL; 心包积液/血清 比值 >0.5)、LDH (>200 mg/dL;血清/心包积液>0.6)、葡萄糖(渗出液 vs 漏出液:77.9±41.9 vs 96.1±50.7 mg/dL )可以鉴别渗出液与漏出液,但是,并不具有直接诊断价值。化脓性积液中葡萄糖值显著降低。WBC计数极低支持黏液水肿;单核细胞显著增高恶性肿瘤或甲状腺功能减退;类风湿病或细胞感染者中性粒细胞均可增高。与细菌培养相比,Gram染色特异性虽高(99%),但敏感性仅38%。联合测定上皮膜抗原、CEA与波形蛋白免疫细胞化学染色可协助鉴别反应性间皮细胞与腺癌细胞。

结核疾病相关标记物
  结核菌素试验主要用于测定人群中结核分枝杆菌的感染,用于诊断结核病是困难的,在发展中国家,由于人群感染率很高加上大面积接种卡介苗,许多健康人结核菌素试验呈阳性反应,但通常接种卡介苗后仅为弱反应,反应直径<10 mm。结核菌素试验阳性反应愈强,作为支持结核病的根据就愈重要,特别是强阳性反应对于儿童有价值,尤其是婴幼儿;另一方面,阴性反应并不能排除结核病。
  腺苷脱氨酶主用来胸腔积液的检验,但部分非结核性胸液仍有升高的特例,不能完全用来作结核性胸水的鉴别。
  结明实验、ICT-TB卡与TB快速卡上述都是结核的血清学诊断方法,简便快捷,是结核的辅助诊断手段,但还不是诊断结核的金标准。结明实验即测定血清中脂阿拉伯甘露糖抗体;特异性较强,有人认为特异性95%以上,敏感性60%左右;ICT-TB卡采用5种结核菌抗原(1种为38 kD、两种分泌蛋白和两种标记蛋白)包被层析条,故可同时检测5种结核菌抗原的抗体,同时又因这5种重组抗原纯度很高,所以检测特异性很强。TB快速卡即测定抗糖脂抗原的抗体。似乎这3种监测方法的测定性能近似。
  ADA为腺苷脱氨酶,目前临床上主用来胸腔积液的检验上,用来作结核性胸水与其它的鉴别。腺苷脱氨酶在体内广泛分布,主要为催化水解腺苷为肌苷和氨的作用,据文献报道该指标在结核性胸液中明显增高,在恶性胸液中明显降低,故可用来作鉴别之用,但部分非结核性胸液仍有升高的特例,因此尚结合临床综合考虑。
  痰涂片及心包积液标本抗酸杆菌检查是利用结核分枝杆菌抗酸染色性的涂片镜检是结核病病原学诊断的直接提示,也是临床早期诊断、判定疗效、估价病情和流行病学监控十分重要的依据。
  所有怀疑结核病和非结核分枝杆菌病的痰标本及心包积液标本均应送分枝杆菌培养。

肿瘤疾病相关标记物
  在肿瘤的研究和临床实践中,早期发现、早期诊断、早期治疗是关键。肿瘤标志物(Tumor Marker TM)在肿瘤普查、诊断、判断预后和转归、评价治疗疗效和高危人群随访观察等方面都具有较大的实用价值。肿瘤标志物检测与临床血清是测定肿瘤标志物最常用的样品,但由于血液的稀释作用,检测的阳性率有一定的局限性,若能直接收集肿瘤组织或其附近组织分泌的体液进行测定,可提高检测灵敏度和特异性。因此,在心包疾病的诊断与治疗中,应将血清与心包积液同时送检肿瘤标记物检查从而综合评价。
  甲胎蛋白(AFP):AFP在胚胎期是功能蛋白,合成于卵黄囊、肝和小肠,脐带血含量为1000~5000 μg/L,1年内降为成人水平<40 μg/L,终生不变。原发性肝细胞癌约70%以上AFP在400 μg/L以上,多逐渐升高,亦有不高于400 μg/L,甚至在正常水平的患者。
  癌胚抗原(CEA):CEA是一种酸性糖蛋白,胚胎期在小肠、肝脏、胰腺合成,成人血清含量极低。CEA l965年被发现时,认为是结肠癌的标志物(60%~90%患者升高),但以后发现胰腺癌(80%)、胃癌(60%)、肺癌(75%)和乳腺癌(60%)也有较高表达。
  糖蛋白抗原是由于细胞膜成分异常糖基化而形成的抗原。
  糖蛋白抗原CA50:是一种唾液酸酯和唾液酸糖蛋白,正常组织中一般不存在,当细胞恶变时,糖基化酶被激活,造成细胞表面糖基结构改变而成为CA50标志物。正常血<20 μg/L,许多恶性肿瘤患者血中皆可升高,如66.6%的肺癌、88.2%的肝癌、68.9%的胃癌、88.5%的卵巢或子宫颈癌、94.4%胰或胆管癌,其他如直肠癌、膀脏癌等皆有70%以上是升高的。
  CA125:最初认为是卵巢癌特异的,但深入研究,它也是一种广谱的标志物。正常值以35 U/mL为界,82.2%卵巢癌、58%胰腺癌、32%肺癌,及其他非妇科肿瘤皆有不同程度的升高,但作为卵巢癌的辅助诊断是个重要的标志物,与病程有关。
  CAl5-3:是乳腺细胞上皮表面糖蛋白的变异体,近年推出作为乳腺癌标志物,正常<40 U/mL哺乳期妇女或良性乳腺肿瘤皆低于此值。乳腺癌晚期100%,其他 期75%此值明显升高。同样,该标志物也是广谱的,可见于50%肝细胞癌、53%肺癌、34%卵巢癌患者。由于CEA在乳腺癌中也有诊断价值,如两者联合将可提高10%阳性率。
  CA19-9:CAl9-9为唾液酸化的乳-N-岩藻戊糖II,是一种类粘蛋白的糖蛋白成分,与Lewis血型成分有关。血清内正常值<37 U/mL(>95%),异常升高也是在多种肿瘤出现,如79%胰腺癌、58%结肠癌、49%肝癌、67%胃癌,如胆囊癌、肺癌、乳腺癌皆有10%左右是升高的。
  CA549:CA549也是乳腺癌的标志物,它是一种酸性糖 蛋白,大部分健康女性<11 U/mL,异常升高者比例并不高,可见于50%乳腺癌、卵巢癌、40%前列腺癌、33%肺癌患者。由此,作为乳腺癌的早期诊断,CA则还较欠缺,应联合应用其它TM。
  CA72-4:CA72-4是一种高分子量糖蛋白,正常人血清中含量<6 U/mL,异常升高在各种消化道肿瘤、卵巢癌均可产生。对于胃癌的检测特异性较高,以>6 U/mL为 临界值。良性胃病仅<1%者升高,而胃癌升高者比例可达42.6%,如与CAl9-9同时检测,阳性率可达56%。
  CA242:是一种粘蛋白型糖抗原,可作为胰腺癌和结肠癌校好的肿瘤标志物,其灵敏度与CA19-9相仿,但特异性、诊断效率则优于CA19-9。
  细胞角蛋白19 (CYFRA21-1)细胞角蛋白是细胞体的中间丝,根据其分子量和等电点不同可分为20种不同类型,其中细胞角蛋白19在肺癌诊断中有很大价值,是小细胞肺癌的重要标志物。在肺癌的血清浓度阈值为2.2 μg/L,其敏感性、特异性及准确性分别为57.7%、91.9%和64.9%。从组织学角度看,鳞癌的敏感性 (76.5%)较腺癌(47.8%)为高,也高于SCC对两者的诊断率。细胞角蛋白19与CEA联合应用,诊断非小细胞肺癌符合率已可达到78%。
  神经原特异性烯醇化酶(NSE):血清NSE是神经内分泌肿瘤的特异性标志,如神经母细胞瘤、甲状腺髓质癌和小细胞肺癌(70%升高)。正常人血清NSE水平<12.5 U/mL目前,NSE已作为小细胞肺癌重要标志物之一。

自身免疫疾病相关标记物
  心包积液分析结果应结合临床症状及其他检查指标如血清学肿瘤标记物、自身抗体标记物与结核标记物进行综合评价。
  自身免疫性疾病患者血循环中常出现针对自身组织器官、细胞及细胞内成分的抗体,称为自身抗体。自身抗体是自身免疫性疾病的重要标志。每种自身免疫性疾病都伴有特征性的自身抗体谱。自身抗体检测在诊断自身免疫性疾病、判断疾病的活动程度、观察治疗效果、指导临床用药等具有重要的临床意义。病人血液中存在高效价自身抗体是自身免疫病的特点之一,也是临床确诊自身免疫性疾病的重要标志之一。主要自身免疫性抗体及其临床意义如下:
  ANA(Antinuclear antibodies)是一类能与多种细胞核抗原反应的自身抗体,许多自身免疫性疾病都可以出现阳性。如系统性红斑性狼疮(SLE)、混合结缔组织病(MTCD)、干燥症(SS)、全身性硬皮病(PSS)。ANA测定在许多胶原病病人均可呈阳性,需进一步作抗DNA抗体和抗ENA抗体测定鉴别。
  抗-dsDNA抗体(double-stranded DNA)在SLE病人的血清中常常可以检测到。美国风湿病学研究院把它作为SLE分类标准的指标之一。
  抗-SS-A (Ro) 在SLE、风湿性关节炎(RA)、干燥综合症病人血清中常常可以检测到SS-A抗体,此外在硬皮病、新生儿红斑性狼疮(NLE)病人也可检测到。
  抗-SS-B (La) 在SLE、风湿性关节炎(RA)、干燥综合症病人血清中常常可以检测到SS-B抗体,在硬皮病、新生儿红斑性狼疮(NLE)病人也可检测到。SS-B抗体一般与SS-A抗体同时出现。若病人血清中可检测到SS-A抗体而不伴有SS-B抗体的出现,此病人继发肾炎的风险较大。
  抗-Sm:30%的SLE病人可检测到抗-Sm抗体,在肾炎病人和某些中枢神经严重损伤的病人也可检测到。
  抗-RNP:高达50%的SLE病人和95%的MCTD病人血清中可检测到此抗体,典型的MCTD病人血清中可检测到高滴度的针对Sm/RNP免疫复合物的抗-RNP抗体,而往往检测不到抗-Sm抗体。
  抗-Scl-70:40%的硬皮病和20-30%的全身性硬皮病患者中可检测到此抗体,很少在其它自身风湿性疾病中出现。
  抗-Jo-1 :20-30%的多发性肌炎/皮肌炎(Polymyositis/Dermatomyositis),30-40%的多发性肌炎患者和高达60%的多发性肌炎伴有间质性肺疾病患者血清中可检测到抗-Jo-1抗体。其它胶原性疾病中很少检出此抗体。
  抗-着丝点抗体:49%~96%的CREST综合症病人可检出抗-着丝点抗体(Anti-Centromere),并伴有雷诺现象(Raynaud's phenomenon)。临床报告病例中硬皮病伴有胆汁性肝硬化病人此抗体也可呈阳性。
  抗-线粒体抗体:抗-线粒体抗体(Anti-Mitochondria)对诊断肝脏疾病很有价值。95%的原发性胆汁性肝硬化病人可检出滴度较高的抗-线粒体抗体。


小结
  结核菌素试验主要用于测定人群中结核分枝杆菌的感染;
  肿瘤标志物在肿瘤普查、诊断、判断预后和转归、评价治疗疗效和高危人群随访观察等方面都具有较大的实用价值;
  自身抗体检测在诊断自身免疫性疾病、判断疾病的活动程度、观察治疗效果、指导临床用药等具有重要的临床意义。

==== 汉译英 ====

Pericardial effusion is a relatively common clinical manifestation, especially in cardiovascular disease, echocardiography became routine inspection methods, the pericardial effusion in patients with marked increase in the detection rate could be as high as 8.4%, the majority of pericardial effusion due to not have clinical signs less. A small number of patients was due to a large number of effusion and pericardial effusion as prominent clinical manifestations. Beware of packages effusion for more than a few months when they continue to pose a chronic pericardial effusion. Leading cause of chronic pericardial effusion There are many, mostly of disease and can affect the pericardium.
Analysis of pericardial effusion diagnosis and treatment of pericardial disease have important guiding significance. Meanwhile, the pericardial effusion results of the analysis should be combined with indicators of clinical symptoms and other tests, such as serum tumor markers, markers and TB autoantibodies markers for comprehensive evaluation.


Analysis of pericardial effusion
Analysis of pericardial effusion can be established viral, bacterial, tuberculous, fungal, cholesterol and malignant pericarditis. Pericardial effusion results of the analysis should also be combined with clinical manifestations. Patients suspected of malignant tumor should be examined, such as cytology and tumor markers carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), carbohydrate antigen CA 125, CA 72-4, CA15-3, CA 19-9, CD-30, CD-25 and so on. Patients suspected of tuberculous pericarditis, should check the acid-fast bacilli staining, Mycobacterium culture, adenosine deaminase (ADA), γ interferon and tuberculosis PCR examination. CEA increased, ADA (adenosine deaminase) to reduce cancer and tuberculosis can identify pericardial effusion. In addition, higher levels of ADA have predictive value of the pericardium to narrow. However, it must be recognized that for TB diagnosis, PCR sensitivity and the ADA similar (75% vs 83%), but the former a higher specificity (100% vs 78%). For suspected bacterial infection, pericardial fluid should also be done with the whole body aerobic anaerobic blood culture 3 times. Cardiac pro-PCR analysis can assist in identifying the virus viral or autoimmune pericarditis. The proportion of the pericardial effusion analysis ( "1015), protein content (> 3.0 g / dL; pericardial effusion / serum ratio> 0.5), LDH (> 200 mg / dL; serum / pericardial effusion" 0.6), glucose ( transudate vs exudate: 77.9 ± 41.9 vs 96.1 ± 50.7 mg / dL) can be identified exudate and transudate, but did not have a direct diagnostic value. Purulent fluid glucose values decreased significantly. WBC count is very low support for myxedema; mononuclear cells were significantly higher malignancy or thyroid dysfunction; rheumatoid arthritis or cells infected neutrophils may be increased. Compared with the bacterial culture, Gram staining, while high specificity (99%), but sensitivity of only 38%. The joint determination of epithelial membrane antigen, CEA and vimentin immunocytochemical staining can help identify reactive mesothelial cells and adenocarcinoma cells.


TB disease-related markers
Tuberculin test is mainly used for determination of population infected with Mycobacterium tuberculosis for diagnosis of tuberculosis is difficult, in developing countries, due to the high infection rate coupled with large-scale BCG vaccination, and many healthy tuberculin test positive response, but usually only a weak reaction after BCG vaccination, the reaction diameter <10 mm. Stronger positive reaction to tuberculin test in support of the TB is based on the more important, especially in response to strong positive value for children, especially infants and young children; the other hand, negative responses and can not rule out TB.
Adenosine deaminase, the main test used to pleural effusion, but some non-tuberculous pleural effusion is still rising a special case, can not be used for identification of tuberculous pleural effusion.
Knot-Ming experiment, ICT-TB card and TB are the fast-card the above-mentioned method of serological diagnosis of tuberculosis, simple and fast, is a means of tuberculosis diagnosis, but not the gold standard for diagnosis of tuberculosis. Knot out experiments that the serum of lipoarabinomannan antibody; specificity strong, it was considered more than 95% specificity, sensitivity 60%; ICT-TB card using five kinds of M. tuberculosis antigens (1 species is 38 kD, 2 kinds of secretory protein and two kinds of marker protein)-coated article chromatography, it can detect five kinds of antibodies to Mycobacterium tuberculosis antigens, while compounded by the five kinds of recombinant antigen with high purity and therefore a strong test specificity. Rapid determination of anti-TB glycolipid antigens card that antibodies. It seems that three kinds of monitoring methods similar to the determination of the performance.
ADA for adenosine deaminase, is currently the primary clinical examination is used to pleural effusion on, used as a tuberculous pleural effusion and other identification. Adenosine deaminase is widely distributed in the body, mainly catalyzed hydrolysis of adenosine to inosine and ammonia's role, it has been reported in the literature of the indicators in tuberculous pleural effusion was significantly higher in malignant pleural effusion was significantly reduced, it can be used to make identification purposes, but some non-tuberculous pleural effusion is still rising a special case, and therefore a combination of clinical comprehensive consideration.
And pericardial effusion specimens of sputum smear examination is the use of acid-fast bacillus Mycobacterium tuberculosis acid-fast dyeing of smear microscopy is the direct prompt diagnosis of TB etiology, but also the early clinical diagnosis, determine the efficacy, disease and epidemiological assessment Monitoring is very important basis.
All suspected TB and non-tuberculous mycobacterial disease in sputum specimens and pericardial effusion specimens should be sent to mycobacterial culture.


Disease-related markers in tumor
In cancer research and clinical practice, early detection, early diagnosis, early treatment is the key. Tumor Markers (Tumor Marker TM) in oncology screening, diagnosis, prognosis and outcome of, evaluate the treatment efficacy and follow-up observation of high-risk groups, etc. have great practical value. Detection of tumor markers and clinical determination of tumor markers in serum is the most commonly used sample, but because of blood dilution effect positive rate of detection has some limitations, if the direct collection of tumor tissue or nearby tissue fluid secretion was measured can improve detection sensitivity and specificity. Thus, pericardial disease, diagnosis and treatment, should be censored at the same time in serum and pericardial effusion tumor marker examination to comprehensive evaluation.
Alpha-fetoprotein (AFP): AFP in the embryonic period of functional proteins, synthesis in the yolk sac, liver and small intestine, umbilical cord blood concentration of 1000 ~ 5000 μg / L, 1 year, fell to adult levels <40 μg / L, life-long change . About 70% of primary hepatocellular carcinoma AFP in the 400 μg / L or more, more gradual, there are no higher than 400 μg / L, even in normal patients.
Carcinoembryonic antigen (CEA): CEA is an acidic glycoprotein, embryo in the small intestine, liver, pancreas synthesis, adult serum were very low. CEA l965 was discovered, considered to be a marker for colon cancer (60% ~ 90% of patients increased), but later discovered to be pancreatic cancer (80%), stomach (60%), lung (75%) and breast cancer ( 60%) also had high expression.
Carbohydrate antigen is due to abnormal glycosylation cell membrane components to form the antigen.
Carbohydrate antigen CA50: is a kind of saliva esters and sialic acid glycoprotein, normal tissues generally do not exist, when the malignant cells, the glycosylase was activated, resulting in structural changes in cell surface glycosylation have become CA50 markers. Normal blood <20 μg / L, Jie Ke blood of many patients with malignant tumors increased, such as the 66.6% of lung cancer, 88.2% of liver cancer, 68.9% of gastric cancer, 88.5% of ovarian or cervical cancer, 94.4% pancreas or bile ducts cancer, others such as cancer, bladder cancer, dirty lend more than 70% is elevated.
CA125: Initially considered to be specific for ovarian cancer, but the in-depth study, it is also a broad-spectrum marker. Normal to 35 U / mL for the sector, 82.2% of ovarian cancer, 58% of pancreatic cancer, 32% of lung cancer, and other non-gynecological tumors have different levels of elevated, but as a secondary diagnosis of ovarian cancer is an important symbol of material, and the course of diseases.
CAl5-3: is a breast epithelial cell surface glycoprotein variants, introduced in recent years as a marker of breast cancer, normal <40 U / mL lactating women, or benign breast tumors are less than this value. Advanced breast cancer, 100%, other 75% of this period was significantly higher. Similarly, the marker is also a broad-spectrum, and can be found in 50% of hepatocellular carcinoma, 53% of lung cancer, 34% of patients with ovarian cancer. As the CEA in breast cancer also has diagnostic value, such as the combination of the two will be able to increase by 10% positive rate.
CA19-9: CAl9-9 for the milk sialyl-N-fucose pentose II, is a type mucin glycoprotein component, and Lewis blood group composition. Serum normal <37 U / mL (> 95%), abnormal increase also occurs in a variety of tumors, such as 79% of pancreatic cancer, 58% of colon cancer, 49% liver, 67% of gastric cancer, such as gallbladder cancer, lung cancer , about 10% of breast cancer Jie You are elevated.
CA549: CA549 is a marker of breast cancer, it is an acidic glycoprotein, most healthy women <11 U / mL, abnormal increase in the proportion is not high, can be found in 50% of breast cancer, ovarian cancer, 40% of prostate cancer, 33% of patients with lung cancer. As a result, the early diagnosis of breast cancer, CA is also short on, should be combined with other TM.
CA72-4: CA72-4 is a high molecular weight glycoprotein, normal human serum concentration <6 U / mL, abnormal increase in a variety of digestive tract cancer, ovarian cancer can be generated. A high specificity for the detection of gastric cancer in order to> 6 U / mL as the threshold. Benign stomach is only "1% were increased while the proportion of gastric cancer increased up to 42.6%, as detected with CAl9-9 at the same time, the positive rate of up to 56%.
CA242: is a mucin-type carbohydrate antigen, can be used as a good school of pancreatic cancer and colon cancer tumor marker, its sensitivity and CA19-9 is similar, but the specificity, diagnostic efficiency is superior to CA19-9.
Cytokeratin 19 (CYFRA21-1) cells, keratin intermediate filaments the cell body, based on their molecular weight and isoelectric point of difference can be divided into 20 different types, including cytokeratin 19 in lung cancer diagnosis has great value, is the important small-cell lung cancer markers. In the lung cancer serum concentration threshold of 2.2 μg / L, the sensitivity, specificity and accuracy were 57.7%, 91.9% and 64.9%. From the histological point of view, the sensitivity of squamous cell carcinoma (76.5%) than adenocarcinoma (47.8%) were high, even higher than the diagnostic rate between SCC pairs. Cytokeratin 19 and CEA in combination, diagnosis, consistent with non-small cell lung cancer rate can reach 78%.
Neuron-specific enolase (NSE): Serum NSE is a specific marker of neuroendocrine tumors such as neuroblastoma, medullary thyroid carcinoma and small cell lung cancer (70% rise). Normal human serum NSE level <12.5 U / mL Currently, NSE has been as a small-cell lung cancer, one of the important markers.


Autoimmune disease-related markers
Pericardial effusion results of the analysis should be combined with indicators of clinical symptoms and other tests, such as serum tumor markers, markers and TB autoantibodies markers for comprehensive evaluation.
Blood circulation in patients with autoimmune diseases frequently directed against its own tissues and organs, cells and intracellular components of antibodies, called autoantibodies. Autoantibodies in autoimmune diseases is an important symbol. Autoimmune diseases are associated with each characteristic spectrum of autoantibodies. Autoantibodies in the diagnosis of autoimmune diseases to determine disease activity, the observed treatment effect, to guide clinical use of drugs and other important clinical significance. Exists in blood of patients with high titers of autoantibodies is a characteristic of autoimmune diseases, autoimmune diseases in clinical diagnosis an important landmark. Major autoimmune antibodies and its clinical significance is as follows:
ANA (Antinuclear antibodies) are a class of reaction with a variety of cell nuclear antigen autoantibodies, and many autoimmune diseases can appear positive. Such as systemic lupus erythematosus (SLE), mixed connective tissue disease (MTCD), dry syndrome (SS), systemic scleroderma (PSS). ANA determination in a number of positive collagen disease patients may be required to further conduct of anti-DNA antibodies and anti-ENA antibody identification.
Anti-dsDNA antibodies (double-stranded DNA) in the SLE patient's serum can often be detected. Research Institute of the American College of Rheumatology SLE classification criteria it as one of the indicators.
Anti-SS-A (Ro) in SLE, rheumatoid arthritis (RA), dry SARS patients can often be detected in serum of SS-A antibodies, In addition, in scleroderma, neonatal lupus erythematosus (NLE) patients were also can be detected.
Anti-SS-B (La) in SLE, rheumatoid arthritis (RA), dry SARS patients can often be detected in serum of SS-B antibodies in scleroderma, neonatal lupus erythematosus (NLE) of patients can also be detected. SS-B antibodies in general and the SS-A antibodies simultaneously. If the patient serum can be detected in SS-A antibodies and not accompanied by the appearance of SS-B antibodies, the secondary nephritis patients at higher risk.
Anti-Sm: 30% of SLE patients to detect anti-Sm antibodies in nephritis patients and patients with serious injury in certain central nervous system can also be detected.
Anti-RNP: up to 50% of SLE patients and 95% of MCTD patients with this antibody can be detected in serum, a typical MCTD serum can be detected in high titer directed against Sm / RNP immune complexes of anti-RNP antibodies, often not detected anti-Sm antibodies.
Anti-Scl-70: 40% of scleroderma, and 20-30% of systemic scleroderma patients with this antibody can be detected and rarely in other rheumatic diseases themselves appear.
Anti-Jo-1 :20-30% of polymyositis / dermatomyositis (Polymyositis / Dermatomyositis) ,30-40% of polymyositis patients and up to 60% of polymyositis associated with interstitial lung disease can be detected in serum of patients with anti-Jo-1 antibody. Other collagen diseases, the antibodies are rarely detected.
Anti - centromere antibody: 49% ~ 96% of CREST syndrome patients can be detected in anti - centromere antibody (Anti-Centromere), and accompanied by Raynaud's phenomenon (Raynaud's phenomenon). Reported cases of clinical biliary cirrhosis associated with scleroderma patients with this antibody can also be positive.
Anti - mitochondrial antibodies: anti---mitochondrial antibody (Anti-Mitochondria) great value in the diagnosis of liver disease. 95% of primary biliary cirrhosis can be detected in patients with high titers of anti - mitochondrial antibodies.


Summary
Tuberculin test is mainly used for determination of population infected with Mycobacterium tuberculosis;
Tumor markers in cancer screening, diagnosis, prognosis and outcome of, evaluate the treatment efficacy and follow-up observation of high-risk groups, etc. have great practical value;
Autoantibodies in the diagnosis of autoimmune diseases to determine disease activity, the observed treatment effect, to guide clinical use of drugs and other important clinical significance.

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更新日期: 2009-11-20 08:09
作者: : mcyclub
修订: 1.1

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