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Sains Malaysiana 52(3)(2023): 887-898
http://doi.org/10.17576/jsm-2023-5203-16
Aplikasi Pengujian Antibodi Anti-Nuklear dalam Menentukan Penyakit Autoimun
Reumatik Sistemik dan Penyakit Berkaitan
(Application of Anti-Nuclear Antibody Test in Diagnosis of Systemic
Autoimmune Rheumatic Diseases and Related Diseases)
ASRUL ABDUL WAHAB*
Jabatan
Mikrobiologi dan Imunologi Perubatan, Fakulti Perubatan, Universiti Kebangsaan
Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Wilayah Persekutuan,
Malaysia
Diserahkan: 27 Ogos
2022/Diterima: 11 Januari 2023
Abstrak
Antibodi anti-nuklear (ANA) merupakan salah satu
contoh autoantibodi yang boleh terbentuk sebelum berlakunya penyakit autoimun
terutamanya penyakit autoimun reumatik sistemik. Disebabkan itu, ANA telah
menjadi satu ujian penting yang dipohon oleh pakar klinikal apabila seseorang
pesakit tersebut disyaki mempunyai penyakit autoimun. Terdapat pelbagai kaedah
makmal yang boleh digunakan untuk mengesan kehadiran ANA dalam darah seseorang
pesakit tetapi kaedah imunofluoresen telah dianggap sebagai kaedah makmal yang
piawai untuk tujuan penyaringan ANA. Kehadiran ANA ini tidaklah khusus kepada
penyakit autoimun kerana tahap kesensitifan dan kekhususannya adalah
berbeza-beza bergantung kepada jenis penyakit autoimun. Penggunaan kaedah
makmal yang berbeza juga telah menunjukkan kadar kesensitifan dan kekhususan
yang berbeza-beza dalam mengesan ANA. Pentafsiran keputusan ANA untuk sesuatu
penyakit autoimun juga terbatas dengan kehadiran ANA yang boleh dikesan dalam
kalangan pesakit yang tidak mempunyai penyakit autoimun malah boleh juga
dikesan dalam kalangan mereka yang sihat. Maklumat klinikal pesakit menjadi
satu unsur yang penting untuk membolehkan pentafsiran ANA yang berkesan dan
juga boleh memberikan panduan kepada ujian selanjutnya jika diperlukan. Dalam
beberapa tahun kebelakangan ini, pengujian ANA menggunakan kaedah
imunofluoresen telah mengalami beberapa pembaharuan termasuklah penubuhan
Kesepakaran Corak ANA Antarabangsa (ICAP) dan pembacaan slaid ANA IF secara
automasi. Pembaharuan yang berlaku ini adalah ke arah penyeragaman pelaporan
pengujian ANA IF. Ulasan ini merangkumi pelbagai kaedah makmal yang boleh
digunakan untuk mengesan ANA, kegunaan klinikal keputusan ANA positif dan
perkembangan terkini dalam pengujian ANA.
Kata
kunci: Antibodi anti-nuklear; asai multiplek; imunoasai enzim; imunofluoresen
Abstract
Anti-nuclear antibody (ANA) is an example of
autoantibodies that precedes the development of autoimmune diseases
particularly systemic autoimmune rheumatic diseases. Thus, ANA is one of the
most common laboratory tests requested by the clinician when there is
suspicious of underlying autoimmune disease in a patient. There are various
laboratory methods that can be used to detect ANA in patient’s blood but for
many years’ indirect immunofluorescence (IF) is considered as a gold standard
for ANA screening. The presence of ANA does not necessarily indicate the
individual has autoimmune disease because the sensitivity and specificity of ANA
varies according to the underlying diseases. Various laboratory methods were
shown to have different sensitivity and specificity in detecting ANA. The
interpretation of ANA and clinical diagnosis are also complicated because ANA
can be detected in non-autoimmune conditions and in healthy population. Thus,
interpretation of ANA requires appropriate clinical information to be
clinically useful and at the same time can suggest if further laboratory test
is needed. In recent years, ANA test through indirect immunofluorescence method
has seen many new developments that include the establishment of the
International Consensus of ANA Pattern (ICAP) and automated ANA IF reader. The
direction of these new developments is towards harmonization of ANA reporting.
This review will provide an overview of different methods of ANA testing, the
clinical utility of ANA positivity and recent advances in ANA testing.
Keywords: Anti-nuclear antibody; enzyme immunoassay;
immunofluorescence; multiplex assay
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*Pengarang untuk surat-menyurat; email: saw@ppukm.ukm.edu.my
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