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Investigation and analysis of HEp 2 indirect immunofluorescence titers and patterns in various liver diseases

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A Correction to this article was published on 02 December 2020

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Abstract

Introduction

Antinuclear antibody (ANA) testing using indirect immunofluorescence assay (IIFA) is a common and economical method which contributes to detect systemic autoimmune diseases (SARD) and autoimmune liver diseases (AILD). The primary aim of our study was to investigate ANA positivity and their patterns in multiple liver diseases, including primary biliary cirrhosis (PBC), autoimmune hepatitis (AIH), hepatitis B virus infection (HBV), hepatitis C virus infection (HCV), and hepatic carcinoma (HCC). Besides, we also compared the ANA titers and patterns in patients with liver disease, SARD, and healthy controls (HC).

Methods

A total of 2537 patients with SARD, 137 PBC cases, 57 AIH cases, 3420 HBV cases, 769 HCV cases, 268 HCC cases, and 1073 HC were retrospectively assessed. The titers and patterns of ANA were detected with the IIFA method.

Results

ANA positivity rate was considerably discernible between these diseases, which is 90.1% in SARD, 93.4% in PBC, 49.1% in AIH, 19.1% in HBV, 13.9% in HCV, and 23.5% in HCC. Moreover, only 4.9% of HCC cases, 2.5% of HBV patients, and 1.6% of HCV patients had an ANA titer ≥ 1:320. The mixed pattern which composed of at least two patterns majorly lied in PBC. AC-15 and AC-21 was frequently related to liver diseases; the former pattern was more frequently found in AIH (84.2%) and PBC (8.8%), and the latter pattern was easily seen in PBC (62.2%) and HCC (22.6%). The positive rate of ANA in HC was 12.2%, and its major pattern was AC-2.

Conclusions

There are differences in ANA positivity among patients with SARD and various liver diseases. Some mixed patterns may provide important evidence for the diagnosis of PBC. Clinicians should pay attention to ANA patterns and titer during the interpretation of this test.

Key Points

• Defining the clinical relevance of antinuclear antibody (ANA) using indirect immunofluorescence assay in the context of diseases can be an important tool for the clinician in the diagnostic work-up of patients with liver diseases.

• The mixed pattern of ANA is majorly found in primary biliary cirrhosis (PBC). ANA patterns including AC-15 and AC-21 are frequently related to liver diseases. AC-15 is more often found in autoimmune hepatitis (AIH) (84.2%) and PBC (8.8%), and AC-21 is easily found in PBC (62.2%, and hepatic carcinoma (HCC) (22.6%).

• ANA positivity can be seen in 19.1% of hepatitis B virus infection (HBV) cases, 13.9% of hepatitis C virus infection (HCV) cases, and 23.5% of HCC cases. Only 2.5% of HBV patients, 1.6% of HCV patients, and 4.9% of HCC cases have an ANA titer ≥ 1:320.

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Change history

  • 02 December 2020

    A Correction to this paper has been published: <ExternalRef><RefSource>https://doi.org/10.1007/s10067-020-05514-5</RefSource><RefTarget Address="10.1007/s10067-020-05514-5" TargetType="DOI"/></ExternalRef>

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Funding

The study was funded by three major construction project of Sun Yat-sen University [grant number 82000-31143401], the establishment of a health management platform for ankylosing spondylitis and hyperuricemia [grant number A2968], National key research and development project [grant number 2016YFC0903501], and Guangzhou Health and Medical Collaborative Innovation Major Projects [grant number 201604020013].

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  1. Qiujing Wei & Yutong Jiang

    Present address: Department of Rheumatology, the Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province, Guangzhou, China

Authors and Affiliations

  1. Department of Rheumatology, the Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province, Guangzhou, China

    Jiewen Xie, Mingcan Yang, Yanli Zhang, Zhongming Wu, Shuhong Chen, Zetao Liao, Zhiming Lin & Jieruo Gu

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Wei, Q., Jiang, Y., Xie, J. et al. Investigation and analysis of HEp 2 indirect immunofluorescence titers and patterns in various liver diseases. Clin Rheumatol 39, 2425–2432 (2020). https://doi.org/10.1007/s10067-020-04950-7

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