Anti-nuclear antibody testing in children: How much is really necessary?
Anti-nuclear antibody testing in children: How much is really necessary?
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DOI：
10.1111/ped.14592
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发表时间：
2021-07-14
影响因子：
1.4
通讯作者：
Kasapcopur, Ozgur
中科院分区：
文献类型：
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作者：
Haslak, Fatih;Yildiz, Mehmet;Kasapcopur, Ozgur
背景 一般儿科医生最常要求进行抗核抗体 (ANA) 检测，以评估患有肌肉骨骼系统疾病的儿童。鉴于该测试的实用性有限，我们的目的是评估在儿童时期进行 ANA 测试的有效性。方法 2008 年至 2020 年间因 ANA 结果呈阳性而转至我科进行检查的儿童被纳入研究。随访时间少于一年的患者、既往患有风湿病或自身免疫性疾病的患者以及首次就诊时诊断为自身免疫和/或风湿性疾病的患者被排除在外。数据是从他们的病历中回顾性获得的。我们通过电话联系了所有患者的家长，核实了数据，并收集了缺失的信息。结果 358 名患者（230 名女性）符合本研究的资格。 ANA 阳性结果的中位年龄为 9.31 (1.3-17.86) 岁，中位随访时间为 4.85 (1-11.91) 年。大多数患者没有基础疾病（n = 337，94.1%）。进行 ANA 检测的最常见原因是评估肌肉骨骼系统症状 (n = 225, 62.8%)。由于 ANA 结果呈阳性而转诊至我们的患者均未出现任何自身免疫性疾病或 ANA 相关风湿病。过度活动综合征是 ANA 阳性患者中最常见的最终诊断。结论 我们建议，仅在强烈怀疑自身免疫性疾病或某些风湿性疾病（例如系统性红斑狼疮）时才应进行 ANA 检测，而不是将其用作筛查工具。
Background Anti-nuclear antibody (ANA) testing is most commonly ordered by general pediatricians to evaluate children with musculoskeletal system complaints. Given the limited utility of the test, we aimed to estimate the effectiveness of ordering ANA testing in childhood. Methods Children referred to our department to be examined due to positive ANA findings between 2008 and 2020 were included in the study. Those with less than one-year follow-up period, those with previously known rheumatic or autoimmune disease, and those diagnosed as an autoimmune and/or rheumatic disease at the first visit were excluded. Data were obtained from their medical records, retrospectively. The parents of all of the patients were called via phone, data were verified, and missing information was collected. Results Three hundred and fifty-eight patients (230 females) were eligible for the study. The median age of positive ANA findings was 9.31 (1.3-17.86) years and the median follow-up duration was 4.85 (1-11.91) years. Most of the patients had no underlying disease (n = 337, 94.1%). The most common reason for ordering ANA testing was to evaluate musculoskeletal system symptoms (n = 225, 62.8%). None of our patients referred to us due to positive ANA findings developed any autoimmune conditions or ANA associated rheumatic disease. Hypermobility syndrome is the most common final diagnosis among our ANA-positive patients. Conclusion We suggest that instead of using it as a screening tool, ANA testing should be performed only if there is a strong suspicion of autoimmune diseases or certain rheumatic conditions, such as systemic lupus erythematosus.