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*It is only for medical professionals to read for reference.
Is it possible to get the test results in 1h? Recently, the “First National Clinical Research Center for Skin and Immune Diseases Year” was co-sponsored by the China Systemic Lupus Erythematosus Research Collaboration Group (CSTAR), the National Rheumatism Data Center (CRDC) and the China Rheumatology and Immunology Medical Association (CRCA).
The CSTAR/CRDC/CRCA Annual Meeting" was successfully held in the capital Beijing.
Under the theme of "Going International, Drawing the Future Together", Professor Hu Chaojun from Peking Union Medical College Hospital gave a wonderful interpretation of the special report on the application and development of autoantibody quantitative detection in the field of clinical rheumatism and immunology, and made a wonderful interpretation of my country's autoantibody Quantitative detection technology has made an outlook, let's take a look! 1.
The status quo of autoantibody detection technology in my country-detection tools are backward, requiring manual operation.
The concept of qualitative and quantitative analysis of autoantibody detection has been put forward in my country for a long time, dating back to 2006, but in the past ten years, most of the domestic The current status of laboratory autoantibody testing is not ideal, and the testing tools used in the laboratory are relatively backward, which leads to problems in the quality and timeliness of testing.
The current mainstream detection methods in China include these types-indirect immunofluorescence, enzyme-linked immunosorbent assay, dot blot and immunoblotting, and linear immunoblotting.
The main problem of these detection methods is the long detection time (up to 2h), which requires batch operation (once the experimental process is started, it must wait for 1 cycle), which cannot meet the clinical "emergency mode".
2.
The backwardness of testing tools directly brings huge problems to the clinic.
We all know that when a clinician faces a patient with fever, the primary problem is to determine whether the cause of the fever is a primary immune disease or a secondary infection.
Hormonal therapy should be used for the former, while antibiotics are the nemesis of the latter.
The key to judging whether the disease is a primary immune disease or a secondary infection is the yin and yang of the antibody test results.
Professor Hu Chaojun showed us the current dilemma of clinicians: “Faced with a patient with severe fever from the emergency room and ICU, if the antibody test result report has been issued, the clinician sees that the result is positive, and uses high-dose glucocorticoids.
(1000mg) shock therapy can solve the problem.
However, in actual situations, clinicians cannot obtain antibody test results within 2 hours.
At this time, the doctor’s choice becomes trial treatment, and the timid doctor chooses to use small Dosage hormone (60mg) treatment, brave doctors venture to try high-dose glucocorticoid (1000mg) shock therapy.
" Professor Hu Chaojun added: "In many critical situations, doctors often choose to take huge risks and bite their teeth.
Give patients a large dose of hormones.
"It can be seen that if the doctor can get the antibody result within 1 hour, it will greatly reduce clinical misdiagnosis and mistreatment.
3.
Automated and quantitative detection has become the development trend of my country's autoantibody detection technology.
The need for clinical diagnosis and treatment is the direction of laboratory efforts.
The current diagnosis and treatment status has put forward a new era of standards for our autoantibody detection-accurate, rapid, quantitative, High throughput and automation.
With a variety of automated autoantibody detection equipment (such as anti-nuclear antibody-ANA, anti-neutrophil cytoplasmic antibody-ANCA, etc.
, automated equipment that uses indirect immunofluorescence to detect total antibodies, as well as specific antibody detection methods and Automation equipment) began to appear, and the automation trend of autoantibody detection in my country is unstoppable.
In addition, quantitative detection technology with higher sensitivity and wider linear range is also the development direction of autoantibody detection in my country.
4.
What value can the emerging autoantibody quantitative detection technology bring? Value 1: "Quantitative" is one of the criteria for disease classification.
The higher the antibody concentration, the greater the diagnostic value.
We know that the diagnosis and treatment guidelines for various rheumatic immune diseases in my country mention the detection of disease-related autoantibodies, and even the detection of antibodies.
The specific strength is precisely required.
Table 1 Several typical rheumatoid diseases and their related autoantibodies.
For example, the guidelines have requirements for the diagnosis of antiphospholipid antibody syndrome (APS), and the diagnosis of rheumatoid arthritis (RA) also has corresponding scoring grades. Figure 1 Several typical rheumatic immune diseases and their related autoantibody strength requirements 2: Antibody "quantification" can be used to monitor the effect of disease treatment Many autoantibodies are involved in the occurrence of the disease (the specific antibodies involved in the occurrence of the disease are as follows , See Figure 2), therefore, the quantitative detection of antibodies can be used to evaluate the condition.
Figure 2 Autoantibodies that can be used for disease assessment 5.
Real-time and quantitative detection of autoantibodies to improve previous academic theories 1 The conclusions of many studies have been overturned and need to be further explored.
Professor Hu Chaojun pointed out that a large number of previous cognitive theories urgently need to be updated.
For example, in the past, anti-Sm antibodies were thought to be the hallmark antibodies of systemic lupus erythematosus (SLE), and their concentration did not change in the human body, but the fact is that all autoantibodies are constantly fluctuating in the human body.
It's just that the sensitivity of the previous inspection methods is not enough, so that we can not capture this change.
As shown in this examination report, the antibodies of the same patient can be changed from strong positive to all negative in the three months of examination report.
Table 2 The same is true for the changes in the concentration of autoantibodies in a certain SLE patient.
The conclusions of a large number of previous studies are based on traditional detection methods.
Previous studies believe that there is no relationship between a certain antibody and a specific disease, which is probably due to the detection method.
Misjudgments caused by backwardness.
For example, there was a time when the ELISA method was unable to separate the amino acid sequence between β-amyloid peptides, and researchers were unable to determine the relationship between β-amyloid peptides and Alzheimer’s disease (AD) until Later, using mass spectrometry technology, it was discovered that β-amyloid peptides can be divided into 38 amino acid sequence, 40 amino acid sequence, and 42 amino acid sequence.
The content of 42 amino acid sequence is quite small, but its concentration changes are closely related to changes in AD.
2 Promoting the revision of the guideline.
The advancement of detection technology not only means that a large amount of research needs to be redone, but also directly promotes the revision of the guideline. In 2002, in the United States and European Union (AECG) classification standards for Sjogren’s syndrome (SS), the double diffusion method was clearly used as the test standard for anti-SSA/Ro antibodies and/or anti-SSB/La antibodies.
However, in 2012, the United States In the SS classification standard established by the Society of Rheumatology (ACR), the double diffusion method is no longer the gold standard, and ELISA, chemiluminescence, and multiple detection methods are better.
6.
What impact can real-time and quantitative detection of autoantibodies have on the clinic? 1 It can help clinical large-scale pedigree testing.
For newly diagnosed patients, there are often multiple autoantibody items in the clinic that require joint testing.
Some items have quantitative or semi-quantitative needs.
This requires a high-throughput, fast, fully automatic, and High-precision detection platform.
The detection speed of chemiluminescence method and flow fluorescence method is quite fast, and the time required for the report is short.
Flow cytometry has a higher detection throughput and can detect dozens of markers at the same time.
Table 3 Comparison of autoantibody detection methods.
Results are obtained at 21 hours, improving the speed of clinical diagnosis and treatment.
Today, the timeliness of autoantibody detection technology has been significantly improved, which can meet the demand for results within 1 hour, which means that autoantibody detection technology has entered " "Emergency mode", this is also a subversion of the entire medical testing industry.
“The results of autoantibody detection in 2-3 days are not taken for granted.
The results in 1-2 hours are the time for autoantibody reporting.
” Professor Hu Chaojun said, “Laboratory autoantibody detection results are not only the result of a single experiment, but also related A doctor’s diagnosis and treatment decisions are related to a living life.
” Looking back at the development of autoantibody detection technology, Professor Hu Chaojun is full of confidence and expectation for the future, and looks forward to: “With the gathering of time, place, and people, autoantibody Real-time, quantitative, and automated testing will surely set sail in 2021.
"7.
Summary Professor Hu Chaojun gave a report on the new concepts and new tools of autoantibody testing technology, expressing that the testing methods of most laboratories in China cannot meet the requirements.
Concerns about the current situation of clinical needs, and proposed that the popularization of the new era autoantibody quantitative detection technology is an effective way to break the lag of disease inspection reports in the field of rheumatism and immunity.
This technology can achieve results within 1 hour, and truly promote the detection of rheumatism and immunity.
Emergency mode" new era.
Is it possible to get the test results in 1h? Recently, the “First National Clinical Research Center for Skin and Immune Diseases Year” was co-sponsored by the China Systemic Lupus Erythematosus Research Collaboration Group (CSTAR), the National Rheumatism Data Center (CRDC) and the China Rheumatology and Immunology Medical Association (CRCA).
The CSTAR/CRDC/CRCA Annual Meeting" was successfully held in the capital Beijing.
Under the theme of "Going International, Drawing the Future Together", Professor Hu Chaojun from Peking Union Medical College Hospital gave a wonderful interpretation of the special report on the application and development of autoantibody quantitative detection in the field of clinical rheumatism and immunology, and made a wonderful interpretation of my country's autoantibody Quantitative detection technology has made an outlook, let's take a look! 1.
The status quo of autoantibody detection technology in my country-detection tools are backward, requiring manual operation.
The concept of qualitative and quantitative analysis of autoantibody detection has been put forward in my country for a long time, dating back to 2006, but in the past ten years, most of the domestic The current status of laboratory autoantibody testing is not ideal, and the testing tools used in the laboratory are relatively backward, which leads to problems in the quality and timeliness of testing.
The current mainstream detection methods in China include these types-indirect immunofluorescence, enzyme-linked immunosorbent assay, dot blot and immunoblotting, and linear immunoblotting.
The main problem of these detection methods is the long detection time (up to 2h), which requires batch operation (once the experimental process is started, it must wait for 1 cycle), which cannot meet the clinical "emergency mode".
2.
The backwardness of testing tools directly brings huge problems to the clinic.
We all know that when a clinician faces a patient with fever, the primary problem is to determine whether the cause of the fever is a primary immune disease or a secondary infection.
Hormonal therapy should be used for the former, while antibiotics are the nemesis of the latter.
The key to judging whether the disease is a primary immune disease or a secondary infection is the yin and yang of the antibody test results.
Professor Hu Chaojun showed us the current dilemma of clinicians: “Faced with a patient with severe fever from the emergency room and ICU, if the antibody test result report has been issued, the clinician sees that the result is positive, and uses high-dose glucocorticoids.
(1000mg) shock therapy can solve the problem.
However, in actual situations, clinicians cannot obtain antibody test results within 2 hours.
At this time, the doctor’s choice becomes trial treatment, and the timid doctor chooses to use small Dosage hormone (60mg) treatment, brave doctors venture to try high-dose glucocorticoid (1000mg) shock therapy.
" Professor Hu Chaojun added: "In many critical situations, doctors often choose to take huge risks and bite their teeth.
Give patients a large dose of hormones.
"It can be seen that if the doctor can get the antibody result within 1 hour, it will greatly reduce clinical misdiagnosis and mistreatment.
3.
Automated and quantitative detection has become the development trend of my country's autoantibody detection technology.
The need for clinical diagnosis and treatment is the direction of laboratory efforts.
The current diagnosis and treatment status has put forward a new era of standards for our autoantibody detection-accurate, rapid, quantitative, High throughput and automation.
With a variety of automated autoantibody detection equipment (such as anti-nuclear antibody-ANA, anti-neutrophil cytoplasmic antibody-ANCA, etc.
, automated equipment that uses indirect immunofluorescence to detect total antibodies, as well as specific antibody detection methods and Automation equipment) began to appear, and the automation trend of autoantibody detection in my country is unstoppable.
In addition, quantitative detection technology with higher sensitivity and wider linear range is also the development direction of autoantibody detection in my country.
4.
What value can the emerging autoantibody quantitative detection technology bring? Value 1: "Quantitative" is one of the criteria for disease classification.
The higher the antibody concentration, the greater the diagnostic value.
We know that the diagnosis and treatment guidelines for various rheumatic immune diseases in my country mention the detection of disease-related autoantibodies, and even the detection of antibodies.
The specific strength is precisely required.
Table 1 Several typical rheumatoid diseases and their related autoantibodies.
For example, the guidelines have requirements for the diagnosis of antiphospholipid antibody syndrome (APS), and the diagnosis of rheumatoid arthritis (RA) also has corresponding scoring grades. Figure 1 Several typical rheumatic immune diseases and their related autoantibody strength requirements 2: Antibody "quantification" can be used to monitor the effect of disease treatment Many autoantibodies are involved in the occurrence of the disease (the specific antibodies involved in the occurrence of the disease are as follows , See Figure 2), therefore, the quantitative detection of antibodies can be used to evaluate the condition.
Figure 2 Autoantibodies that can be used for disease assessment 5.
Real-time and quantitative detection of autoantibodies to improve previous academic theories 1 The conclusions of many studies have been overturned and need to be further explored.
Professor Hu Chaojun pointed out that a large number of previous cognitive theories urgently need to be updated.
For example, in the past, anti-Sm antibodies were thought to be the hallmark antibodies of systemic lupus erythematosus (SLE), and their concentration did not change in the human body, but the fact is that all autoantibodies are constantly fluctuating in the human body.
It's just that the sensitivity of the previous inspection methods is not enough, so that we can not capture this change.
As shown in this examination report, the antibodies of the same patient can be changed from strong positive to all negative in the three months of examination report.
Table 2 The same is true for the changes in the concentration of autoantibodies in a certain SLE patient.
The conclusions of a large number of previous studies are based on traditional detection methods.
Previous studies believe that there is no relationship between a certain antibody and a specific disease, which is probably due to the detection method.
Misjudgments caused by backwardness.
For example, there was a time when the ELISA method was unable to separate the amino acid sequence between β-amyloid peptides, and researchers were unable to determine the relationship between β-amyloid peptides and Alzheimer’s disease (AD) until Later, using mass spectrometry technology, it was discovered that β-amyloid peptides can be divided into 38 amino acid sequence, 40 amino acid sequence, and 42 amino acid sequence.
The content of 42 amino acid sequence is quite small, but its concentration changes are closely related to changes in AD.
2 Promoting the revision of the guideline.
The advancement of detection technology not only means that a large amount of research needs to be redone, but also directly promotes the revision of the guideline. In 2002, in the United States and European Union (AECG) classification standards for Sjogren’s syndrome (SS), the double diffusion method was clearly used as the test standard for anti-SSA/Ro antibodies and/or anti-SSB/La antibodies.
However, in 2012, the United States In the SS classification standard established by the Society of Rheumatology (ACR), the double diffusion method is no longer the gold standard, and ELISA, chemiluminescence, and multiple detection methods are better.
6.
What impact can real-time and quantitative detection of autoantibodies have on the clinic? 1 It can help clinical large-scale pedigree testing.
For newly diagnosed patients, there are often multiple autoantibody items in the clinic that require joint testing.
Some items have quantitative or semi-quantitative needs.
This requires a high-throughput, fast, fully automatic, and High-precision detection platform.
The detection speed of chemiluminescence method and flow fluorescence method is quite fast, and the time required for the report is short.
Flow cytometry has a higher detection throughput and can detect dozens of markers at the same time.
Table 3 Comparison of autoantibody detection methods.
Results are obtained at 21 hours, improving the speed of clinical diagnosis and treatment.
Today, the timeliness of autoantibody detection technology has been significantly improved, which can meet the demand for results within 1 hour, which means that autoantibody detection technology has entered " "Emergency mode", this is also a subversion of the entire medical testing industry.
“The results of autoantibody detection in 2-3 days are not taken for granted.
The results in 1-2 hours are the time for autoantibody reporting.
” Professor Hu Chaojun said, “Laboratory autoantibody detection results are not only the result of a single experiment, but also related A doctor’s diagnosis and treatment decisions are related to a living life.
” Looking back at the development of autoantibody detection technology, Professor Hu Chaojun is full of confidence and expectation for the future, and looks forward to: “With the gathering of time, place, and people, autoantibody Real-time, quantitative, and automated testing will surely set sail in 2021.
"7.
Summary Professor Hu Chaojun gave a report on the new concepts and new tools of autoantibody testing technology, expressing that the testing methods of most laboratories in China cannot meet the requirements.
Concerns about the current situation of clinical needs, and proposed that the popularization of the new era autoantibody quantitative detection technology is an effective way to break the lag of disease inspection reports in the field of rheumatism and immunity.
This technology can achieve results within 1 hour, and truly promote the detection of rheumatism and immunity.
Emergency mode" new era.
