Comparison of fixed cell-based assay to radioimmunoprecipitation assay for acetylcholine receptor antibody detection in myasthenia gravis
Comparison of fixed cell-based assay to radioimmunoprecipitation assay for acetylcholine receptor antibody detection in myasthenia gravis
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DOI：
10.1016/j.jns.2021.120084
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发表时间：
2022-01-15
影响因子：
4.4
通讯作者：
Budhram, Adrian
中科院分区：
文献类型：
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作者：
Mirian, Ario;Nicolle, Michael W.;Budhram, Adrian
目的：比较市售固定细胞法（F-CBA）与放射免疫沉淀法（RIPA）检测乙酰胆碱受体抗体的特异性和灵敏度方法：在这项回顾性诊断队列研究中，我们回顾了在伦敦健康科学中心MG诊所接受过抗AChR RIPA和F-CBA治疗的疑似MG患者的临床信息，将其分为MG和非MG。每个患者的分类为抗AChR F-CBA阴性/阳性，RIPA阴性/阳性，MG/非MG允许的特异性和敏感性计算为每个assay.Results：六百十八例患者被纳入研究分析。样本采集时的中位患者年龄为45.8岁（范围：7.5-87.5岁），312/618（50.5%）为女性。在618例患者中，395例（63.9%）被归类为MG。F-CBA和RIPA的特异性均为99.6%，与100%比较，P > 0.99。1例F-CBA阳性患者被归类为非MG，尽管回顾性分析发现眼部MG伴功能性重叠难以排除。F-CBA的敏感性显著高于RIPA（76.7% vs. 72.7%，P = 0.002）。总的来说，20/97（21%）的其他血清阴性MG（SNMG）患者后，RIPA评估有抗AChR检测F-CBA。结论：在我们的研究中，抗AChR F-CBA和RIPA都有很好的特异性，而F-CBA有4%的敏感性高出MG和21%的SNMG患者中检测到抗AChR。我们的研究结果表明，F-CBA是一个可行的替代RIPA抗AChR检测。需要进行前瞻性研究，比较F-CBA，RIPA和L-CBA，以确定MG的最佳抗AChR检测算法。
Objective: To compare specificity and sensitivity of a commercially available fixed cell-based assay (F-CBA) to radioimmunoprecipitation assay (RIPA) for acetylcholine receptor antibody (anti-AChR) detection in myasthenia gravis (MG).Methods: In this retrospective diagnostic cohort study we reviewed the clinical information of suspected MG patients evaluated at the London Health Sciences Centre MG clinic who had anti-AChR RIPA and then F-CBA performed, in order to classify them as MG or non-MG. Classification of each patient as anti-AChR F-CBA-negative/positive, RIPA-negative/positive, and MG/non-MG permitted specificity and sensitivity calculations for each assay.Results: Six-hundred-eighteen patients were included in study analysis. The median patient age at time of sample collection was 45.8 years (range: 7.5-87.5 years) and 312/618 (50.5%) were female. Of 618 patients, 395 (63.9%) were classified as MG. Specificity of both F-CBA and RIPA was excellent (99.6% vs. 100%, P > 0.99). One F-CBA-positive patient was classified as non-MG, although in retrospect ocular MG with functional overlay was challenging to exclude. Sensitivity of F-CBA was significantly higher than RIPA (76.7% vs. 72.7%, P = 0.002). Overall, 20/97 (21%) otherwise seronegative MG (SNMG) patients after RIPA evaluation had anti-AChR detected by F-CBA.Conclusions: In our study anti-AChR F-CBA and RIPA both had excellent specificity, while F-CBA had 4% higher sensitivity for MG and detected anti-AChR in 21% of SNMG patients. Our findings indicate that F-CBA is a viable alternative to RIPA for anti-AChR detection. Prospective studies comparing F-CBA, RIPA and L-CBA are needed to determine optimal anti-AChR testing algorithms in MG.