{"id":10023,"date":"2020-04-23T04:54:15","date_gmt":"2020-04-23T01:54:15","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/profil-miozita-blot\/"},"modified":"2025-02-05T14:17:43","modified_gmt":"2025-02-05T12:17:43","slug":"profil-miozita-blot","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/profil-miozita-blot\/","title":{"rendered":"Profil miozita – Blot"},"content":{"rendered":"

Informa<\/em><\/strong>\u0163<\/em><\/strong>ii generale \u015fi recomand\u0103ri pentru determinarea profilului miozit\u0103<\/em><\/strong><\/p>\n

Miopatiile inflamatorii idiopatice reprezint\u0103 un\u00a0 grup de afec\u0163iuni caracterizate prin sl\u0103biciunea musculaturii proximale a membrelor, atrofie muscular\u0103, semne biochimice \u015fi electromiografice de leziune muscular\u0103, anomalii histologice, modific\u0103ri cutanate caracteristice. Apar cu o inciden\u0163\u0103 de 0,1-1\/100 000 locuitori\/an \u015fi sunt mai frecvente la femei. Din acest grup fac parte: polimiozita, dermatomiozita, miozita cu corpi de incluziune, miozita asociat\u0103 cu neoplazie (sindrom paraneoplazic) \u015fi miozita asociat\u0103 cu alte boli ale \u0163esutului conjunctiv6;7<\/sup>.<\/p>\n

Din punct de vedere histologic, miozita poate fi diferen\u0163iat\u0103 \u00een miozit\u0103 intersti\u0163ial\u0103 f\u0103r\u0103 distruc\u0163ia fibrei musculare, miozit\u0103 focal\u0103 cu infiltrat inflamator \u015fi leziuni ale fibrei musculare \u015fi miozit\u0103 difuz\u0103.<\/div>\n
Polimiozita (PM)\u00a0 se caracterizeaz\u0103 clinic prin febr\u0103, sl\u0103biciune muscular\u0103, artralgii, posibil sindrom Raynaud.<\/div>\n
\u00cen dermatomiozit\u0103 (DM)\u00a0pacien\u0163ii prezint\u0103 eritem violaceu periorbital asociat sau nu cu edem, eritem care se poate extinde ulterior pe bra\u0163e, m\u00e2ini \u015fi membre inferioare.<\/div>\n
Testele de laborator eviden\u0163iaz\u0103 cre\u015fterea enzimelor musculare (CK, AST, LDH) \u015fi pozitivitatea marker-ilor de inflama\u0163ie (CRP, VSH).<\/div>\n

Ca \u015fi \u00een cazul sclerozei sistemice, autoanticorpii specifici joac\u0103 un rol major \u00een diagnosticul \u015fi clasificarea diferitelor variante ale acestor afec\u0163iuni (incluz\u00e2nd \u015fi sindroamele overlap<\/em>), cu at\u00e2t mai mult cu cat prevalen\u0163a anticorpilor antinucleari este marcat sc\u0103zut\u0103 (40-60%) comparativ cu lupusul eritematos sistemic. Ace\u015fti autoanticorpi recunosc \u0163inte antigenice multiple: tipuri de ARN de transfer (ARNt), aminoacil-t-ARN-sintetaze, componente ale particulei de recunoa\u015ftere a semnalului (\u201csignal recognition particle\u201d, SRP), factori transla\u0163ionali, componente ale complexului de remodelare a nucleozomului, \u00eens\u0103 cei mai importan\u0163i sunt cei direc\u0163iona\u0163i \u00eempotriva aminoacil-t-ARN-sintetazelor (familie de enzime care se g\u0103se\u015fte \u00een toate celulele nucleate \u015fi care are rolul de a ata\u015fa un anumit aminoacid de ARNt-ul propriu). Prezen\u0163a autoanticorpilor se asociaz\u0103 cu anumite subseturi de boal\u0103, av\u00e2nd valoare predictiv\u0103 pentru diferite manifest\u0103ri clinice \u015fi pentru prognosticul bolii1;2;6;7<\/sup>.<\/p>\n

Anticorpii anti-Jo-1<\/span><\/strong> sunt \u00eendrepta\u0163i \u00eempotriva enzimei histidil-t-ARN sintetaza. In vitro<\/em> ace\u015fti autoanticorpi se leag\u0103 de epitopii conforma\u0163ionali ai enzimei \u015fi \u00eei inhib\u0103 activitatea catalitic\u0103. Antigenul este sub form\u0103 dimeric\u0103 \u015fi este localizat\u00a0 \u00een citoplasm\u0103; masa molecular\u0103 a subunit\u0103\u0163ilor este 50 kDa. Prevalen\u0163a anticorpilor anti-Jo-1 \u00een polimiozit\u0103 \u015fi dermatomiozit\u0103 este de 20-40%; autoanticorpii pot fi detecta\u0163i precoce, uneori preced\u00e2nd debutul simptomelor. La copii anticorpii anti-Jo-1 sunt extrem de rari. Pacien\u0163ii cu anticorpi anti-Jo-1 prezint\u0103 o triad\u0103 tipic\u0103 de simptome: polimiozita (>90%), polisinovita (artralgii, artrita deformant\u0103 noneroziva, tenosinovita \u00een 50% din cazuri), alveolita fibrozant\u0103 sau fibroza pulmonar\u0103 (60%). Se mai pot ad\u0103uga: fenomen Raynaud (40%), febr\u0103 (20%), \u201cm\u00e2na mecanicului\u201d (30%). Acest tablou este cunoscut sub numele de sindrom anti-sintetaza<\/em>. Mai mult de 90% din pacien\u0163ii caucazieni cu anti-Jo-1 prezint\u0103 alela HLA DR31;4;6;7<\/sup>.<\/p>\n

De\u015fi anticorpii direc\u0163iona\u0163i asupra altor aminoacil-t-ARN-sintetaze: anti-PL-7<\/span> (anti-treonil-t-ARN-sinteza), anti-PL-12<\/span> (anti-alanil-t-ARN-sintetaza), anti-EJ<\/span> (anti-glicil-t-ARN-sintetaza) \u015fi anti-OJ<\/span> (anti-leucil-t-ARN-sintetaza) sunt mult mai pu\u0163in frecven\u0163i dec\u00e2t anti-Jo-1, ace\u015ftia sunt asocia\u0163i cu acelea\u015fi manifest\u0103ri clinice compatibile cu sindromul anti-sintetaza6<\/sup>. De obicei un pacient prezint\u0103 un singur tip de anticorpi anti-sintetaza, dar au fost descrise \u015fi cazuri \u00een care au fost depista\u0163i to\u0163i cei 5 autoanticorpi. Sindromul anti-sintetaz\u0103 r\u0103spunde moderat la terapia cortizonic\u0103. Deoarece toate sintetazele se g\u0103sesc \u00een citoplasm\u0103 (sediul sintezei proteice), autoanticorpii determin\u0103 un aspect fin\u00a0citoplasmatic \u00een imunofluorescen\u0163a indirect\u0103 ce folose\u015fte ca substrat celulele Hep-21<\/sup>.<\/p>\n

Anti-PL-7<\/span><\/strong> apar cu o prevalen\u0163\u0103 de 3-6% la pacien\u0163i cu miozit\u0103, mai ales \u00een sindroame overlap (LES, scleroza sistemic\u0103, fibroza pulmonar\u0103 intersti\u0163ial\u0103).<\/p>\n

Anti-PL12<\/span><\/strong> sunt detecta\u0163i cu o prevalen\u0163\u0103 de 3% la pacien\u0163i cu miozit\u0103.<\/p>\n

Anti-EJ<\/span><\/strong>\u00a0si anti-OJ<\/span><\/strong> apar \u00een polimiozit\u0103, dar \u015fi \u00een sindroame overlap3<\/sup>.<\/p>\n

Anticorpii anti-Mi-2<\/span><\/strong> sunt \u00eendrepta\u0163i \u00eempotriva helicazei nucleare (complex proteic nuclear implicat \u00een reglarea transcrip\u0163iei); apar la 15-30% dintre pacien\u0163ii cu dermatomiozit\u0103\u00a0\u00a0(av\u00e2nd specificitate mare pentru aceast\u0103 afec\u0163iune) \u015fi rar la pacien\u0163i cu polimiozit\u0103. Cei mai mul\u0163i dintre pacien\u0163ii cu anticorpi anti-Mi-2 sunt purt\u0103tori ai alelei HLA DR7. Forma de boal\u0103 este benign\u0103, cu r\u0103spuns bun la terapia cortizonic\u01036;7<\/sup>.<\/p>\n

Anticorpii anti-Ku<\/span><\/strong> sunt \u00eendrepta\u0163i \u00eempotriva unui antigen proteic nucleolar de tip heterodimer, compus din dou\u0103 subunit\u0103\u0163i cu mas\u0103 molecular\u0103 de 70 \u015fi respectiv 80 kDa, component al unui complex enzimatic al proteinkinazei dependente de ADN. Acest complex de\u0163ine un rol important \u00een procese celulare legate de transla\u0163ie, repararea ADN-ului \u015fi rearanjarea genelor implicate \u00een sinteza imunoglobulinelor, precum \u015fi a receptorilor celulelor T. Anticorpii anti-Ku sunt \u00eent\u00e2lni\u0163i \u00eentr-un spectru larg de boli ale \u0163esutului conjunctiv, \u00een special sindroame overlap sclerodermie-miozit\u0103, dar \u015fi LES (3-10%). Aspectul \u00een imunofluorescen\u0163a indirect\u0103 este de tip granular (patat); de asemenea a fost descris\u0103 o asociere cu alela HLA DQw1. Prevalen\u0163a anticorpilor anti-Ku \u00een afec\u0163iunile autoimune este variabil\u0103, originea etnic\u0103 fiind un element important. Spre exemplu, \u00een America de Nord \u015fi Europa au fost descrise cazuri de LES asocia\u0163i cu anticorpi anti-Ku, dar nu \u015fi \u00een Japonia. Sindromul Sj\u00f6gren primar, ca \u015fi hipertensiunea pulmonar\u0103 primitiv\u0103 constituie alte condi\u0163ii clinice frecvent asociate cu anti-Ku.<\/p>\n

Anticorpii anti PM-Scl<\/span><\/strong> sunt \u00eendrepta\u0163i \u00eempotriva complexului nucleolar compus din 11-16 polipeptide, a c\u0103ror func\u0163ie nu a fost \u00eenc\u0103 determinat\u01036<\/sup>. Anticorpii sunt detecta\u0163i \u00een peste 90% din cazurile de sindrom overlap\u00a0 sclerodermie-polimiozit\u0103 (sclerodermatomiozit\u0103), dar numai la ~8% din toate cazurile de miozit\u0103 \u015fi ~3% din toate cazurile de sclerodermie5<\/sup>. Prognosticul este relativ favorabil la acest grup de pacien\u0163i. Se asociaz\u0103 cu HLA DR3 \u015fi anticorpi anti-nucleari cu aspect nucleolar omogen \u00een imunofluorescen\u0163\u01032;6<\/sup>. In laborator se detecteaz\u0103 separat cei doi autoanticorpi principali: anti PM-Scl100<\/strong> \u0438 anti PM-Scl75<\/strong>3<\/sup>.<\/p>\n

Anti-SRP<\/span><\/strong> (\u201csignal recognition particle\u201d) reac\u0163ioneaz\u0103 cu un component de 54 kDa al complexului SRP care are rolul de a media transportul de proteine nou sintetizate spre reticulul endoplasmatic. Au fost descri\u015fi la pacien\u0163i cu polimiozit\u0103 \u015fi dermatomiozit\u0103 (p\u00e2n\u0103 la 4% din cazuri), \u00een special la femei de ras\u0103 neagr\u0103. Anti-SRP sunt markeri pentru miopatia necrozant\u0103 caracterizat\u0103 prin sl\u0103biciune acut\u0103 sever\u0103 proximal\u0103 \u015fi simetric\u0103 a musculaturii scheletice asociat\u0103 cu durere muscular\u0103; este afectat\u0103 \u015fi musculatura cardiac\u0103. Boala se asociaz\u0103 cu rat\u0103 de mortalitate crescut\u0103 \u015fi r\u0103spuns slab la terapia cortizonic\u01036;7<\/sup>.<\/p>\n

Anti-Ro52<\/span><\/strong> sunt \u00eendrepta\u0163i \u00eempotriva unui antigen de 52kDa \u015fi au fost descri\u015fi ca autoanticorpi nespecifici asocia\u0163i cu boli reumatice \u015fi non-reumatice. Sunt prezen\u0163i \u00eentr-un procent de 100% la mamele fe\u0163ilor sau nou-n\u0103scu\u0163ilor cu bloc atrio-ventricular congenital sau lupus neonatal6<\/sup>. Un anumit procent de pacien\u0163i cu polimiozit\u0103\/dermatomiozit\u0103 prezint\u0103 Anti-Ro52 \u00een asociere cu anticorpii anti-aminoacil-t-ARN-sintetaz\u0103 (\u00een special anti-Jo-1)1;2<\/sup>.<\/p>\n

Preg\u0103tire pacient <\/em><\/strong>- <\/em>\u00e0 jeun (pe nem\u00e2ncate) sau postprandial (dup\u0103 mese)3.<\/sup><\/p>\n

Specimen recoltat <\/em><\/strong>- <\/em>\u0432\u0435\u043d\u043e\u0437\u043d\u0430\u044f \u043a\u0440\u043e\u0432\u044c3<\/sup>.<\/p>\n

Recipient de recoltare <\/em><\/strong>- <\/em>vacutainer f\u0103r\u0103 anticoagulant cu\/f\u0103r\u0103 gel separator3<\/sup>.<\/p>\n

Prelucrare necesar\u0103 dup\u0103 recoltare <\/em><\/strong>- <\/em>se separ\u0103 serul prin centrifugare3<\/sup>.<\/p>\n

Volum prob\u0103<\/em><\/strong> \u2013 minim 1 mL ser3<\/sup>.<\/p>\n

Cauze de respingere<\/em><\/strong> a probei<\/em><\/strong><\/p>\n

\u2022 specimen hemolizat;<\/div>\n
\u2022 specimen icteric, lipemic;<\/div>\n
\u2022 specimen contaminat bacterian3<\/sup>.<\/div>\n

Stabilitate prob\u0103 <\/em><\/strong>- <\/em>serul separat este stabil 14 zile<\/em> la 2-8\u00baC \u015fi timp \u00eendelungat<\/em> la -20\u00baC. Nu decongela\u0163i\/recongela\u0163i3<\/sup>.<\/p>\n

Metod\u0103 <\/em><\/strong>- imunoblot<\/span>. Antigenele utilizate sunt native (Jo-1)\u00a0 \u015fi recombinate.<\/p>\n

Strip-urile sunt alc\u0103tuite din cip-uri membranare fixate cu diverse antigene purificate: Mi-2, Ku, PM-Scl 100, PM-Scl 75, Jo-1, SRP, PL-7, PL-12, EJ, OJ, Ro-52.<\/p>\n

\u00centr-o prim\u0103 etap\u0103 strip-ul \u00eenc\u0103rcat cu antigenele purificate este incubat \u00eempreun\u0103 cu serul diluat al pacientului. Dac\u0103 \u00een ser sunt prezen\u0163i anticorpi specifici ace\u015ftia se vor lega de antigenele corespunz\u0103toare de pe strip. Dup\u0103 o etap\u0103 de sp\u0103lare, strip-ul este incubat cu un conjugat anti-IgG uman marcat cu fosfataz\u0103 alcalin\u0103. Conjugatul se va ata\u015fa la por\u0163iunea IgG a complexului antigen-anticorp. Dup\u0103 \u00eendep\u0103rtarea prin sp\u0103lare a conjugatului nelegat se adaug\u0103 solu\u0163ia de colorare (substratul enzimei) \u2013 un sistem de detec\u0163ie enzimatic\u0103 colorimetric\u0103. Dac\u0103 este prezent conjugatul legat reac\u0163ia enzimatic\u0103 va genera un produs colorat albastru-inchis la nivelul benzilor ocupate de anticorpi specifici. Astfel, benzile vizualizate la nivelul stripului sunt rezultatul leg\u0103rii\u00a0 anticorpilor specifici de antigenele individuale de la nivelul strip-ului.<\/p>\n

Pe fiecare strip\u00a0 exist\u0103 o band\u0103 de control intern. Apari\u0163ia unei reac\u0163ii de culoare intense la acest nivel certific\u0103 faptul c\u0103 toate etapele testului imunoblot au fost executate corect3<\/sup>.<\/p>\n

Interpretarea definitiv\u0103 a rezultatelor testului se face cu ajutorul unui software (dup\u0103 scanarea strip-urilor) care \u00een func\u0163ie de intensitatea semnalului, acord\u0103 un punctaj pentru fiecare band\u0103 a strip-ului, astfel:<\/p>\n\n\n\n\n\n\n\n
\n

EVALUARE SEMNAL<\/strong><\/p>\n<\/td>\n

\n

INTENSITATE\u00a0 SEMNAL<\/strong><\/p>\n<\/td>\n

\n

REZULTAT<\/strong><\/p>\n<\/td>\n<\/tr>\n

F\u0103r\u0103\u00a0 band\u0103<\/td>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 0-5<\/td>\n0<\/td>\nF\u0103r\u0103\u00a0 band\u0103<\/td>\n<\/tr>\n
Band\u0103 slab\u0103<\/td>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 6-10<\/td>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 (+)<\/td>\nBand\u0103 slab\u0103<\/td>\n<\/tr>\n
Band\u0103 medie-intens\u0103<\/td>\n\u00a0\u00a0 11-25 sau 26-50<\/td>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 +,++<\/td>\nBand\u0103 medie-intens\u0103<\/td>\n<\/tr>\n
Band\u0103 foarte intens\u0103<\/td>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 >50<\/td>\n\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 +++<\/td>\nBand\u0103 foarte intens\u0103<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
<\/div>\n
\u00cen final este calculat\u0103 suma\u00a0 punctelor acordate \u015fi se va genera rezultatul testului.<\/div>\n
Un rezultat pozitiv confirm\u0103 prezen\u0163a anticorpilor specifici.<\/div>\n
Un rezultat echivoc indic\u0103 faptul c\u0103 prezen\u0163a auto- anticorpilor este incert\u0103; \u00een func\u0163ie de contextul clinic al pacientului testul va fi repetat la un interval de 1-2 luni.<\/div>\n
Un rezultat negativ indic\u0103 absen\u0163a auto-anticorpilor specifici.<\/div>\n

Valori de referin\u0163\u0103 <\/em><\/strong><\/p>\n

Anti-Mi-2: negativ<\/div>\n
Anti-Ku: negativ<\/div>\n
Anti-PM-Scl100: negativ<\/div>\n
Anti-PM-Scl75: negativ<\/div>\n
Anti-Jo-1: negativ<\/div>\n
Anti-SRP: negativ<\/div>\n
Anti-PL-7: negativ<\/div>\n
Anti-PL-12: negativ<\/div>\n
Anti-EJ: negativ<\/div>\n
Anti-OJ: negativ<\/div>\n
Anti-Ro-52: negativ3<\/sup><\/div>\n

Interpretarea rezultatelor<\/em><\/strong><\/p>\n

Identificarea anticorpilor anti-aminoacil-tARN-sintetaze se asociaz\u0103 puternic cu sindromul anti-sintetaza. Asocierea miozitei cu autoanticorpi anti-SRP define\u015fte o form\u0103 sever\u0103 de polimiozit\u0103 cu manifest\u0103ri cardiovasculare \u015fi rata crescut\u0103 a mortalit\u0103\u0163ii. Prezen\u0163a anticorpilor anti-Mi-2 define\u015fte dermatomiozita clasic\u0103 cu rash cutanat, eritem periunghial \u015fi r\u0103spuns bun la terapia cortizonic\u0103. Anticorpii men\u0163ionati reprezint\u0103 autoanticorpi specifici miozitei<\/span>7<\/sup><\/span>.<\/p>\n

Dou\u0103 studii clinice recente au furnizat urm\u0103toarele date privind prevalen\u0163a \u015fi specificitatea autoanticorpilor depista\u0163i prin tehnica imunoblot la pacien\u0163i cu miozit\u01033<\/sup>:<\/p>\n\n\n\n\n\n\n\n\n\n\n
\n

STUDIUL 1<\/strong><\/p>\n<\/td>\n

\n

STUDIUL 2<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Anti-<\/strong><\/p>\n<\/td>\n

\n

Prevalen\u0163a<\/strong><\/p>\n<\/td>\n

\n

Specificitate<\/strong><\/p>\n<\/td>\n

\n

Anti-<\/strong><\/p>\n<\/td>\n

\n

Prevalen\u0163a<\/strong><\/p>\n<\/td>\n

\n

Specificitate<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Mi-2<\/p>\n<\/td>\n

\n

3%<\/p>\n<\/td>\n

\n

100%<\/p>\n<\/td>\n

\n

Mi-2<\/p>\n<\/td>\n

\n

4%<\/p>\n<\/td>\n

\n

98%<\/p>\n<\/td>\n<\/tr>\n

\n

Ku<\/p>\n<\/td>\n

\n

3%<\/p>\n<\/td>\n

\n

97%<\/p>\n<\/td>\n

\n

Ku<\/p>\n<\/td>\n

\n

5%<\/p>\n<\/td>\n

\n

95%<\/p>\n<\/td>\n<\/tr>\n

\n

Pm-Scl100<\/p>\n<\/td>\n

\n

7%<\/p>\n<\/td>\n

\n

100%<\/p>\n<\/td>\n

\n

Pm-Scl100<\/p>\n<\/td>\n

\n

4%<\/p>\n<\/td>\n

\n

100%<\/p>\n<\/td>\n<\/tr>\n

\n

Jo-1<\/p>\n<\/td>\n

\n

12%<\/p>\n<\/td>\n

\n

100%<\/p>\n<\/td>\n

\n

Jo-1<\/p>\n<\/td>\n

\n

21%<\/p>\n<\/td>\n

\n

100%<\/p>\n<\/td>\n<\/tr>\n

\n

PL-7<\/p>\n<\/td>\n

\n

2%<\/p>\n<\/td>\n

\n

100%<\/p>\n<\/td>\n

\n

PL-7 sau PL-12<\/p>\n<\/td>\n

\n

4%<\/p>\n<\/td>\n

\n

100%<\/p>\n<\/td>\n<\/tr>\n

\n

PL-12<\/p>\n<\/td>\n

\n

0%<\/p>\n<\/td>\n

\n

100%<\/p>\n<\/td>\n

<\/td>\n<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
<\/div>\n
Limite \u015fi interferen\u0163e<\/em><\/strong><\/div>\n
Anticorpii anti-PM-Scl, anti-Ku \u015fi anti-Ro52 sunt considera\u0163i autoanticorpi asocia\u0163i miozitei<\/span> care, fiind lipsi\u0163i de specificitate, se \u00eent\u00e2lnesc \u015fi \u00een alte afec\u0163iuni ale \u0163esutului conjunctiv3;7<\/sup>.<\/div>\n

\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/strong><\/p>\n

1.\u00a0Athanasios G. Tzioufas. Antisynthetase Syndrome. In Orphanet Encyclopedia, Nov. 2001. Ref Type: Internet Communication.<\/span><\/div>\n
2. Carlos Albertos von M\u00fchlen, Robert M. Nakamura. Clinical and Laboratory Evaluation of Systemic Rheumatic Diseases. In Henry\u2019s Clinical\u00a0<\/em>Diagnosis and Management by Laboratory Methods<\/em>, Saunders-Elsevier, 21st Edition, 8, 919, 923.<\/span><\/div>\n
3. <\/em>Laborator Synevo. Referin\u0163ele specifice tehnologiei de lucru utilizate 2012. Ref Type: Catalog.<\/span><\/div>\n
4.\u00a0Mayo Clinic. Mayo Medical Laboratories. Test Catalog: Jo 1 Antibodies, IgG, Serum. www.mayomedicallaboratories.com<\/a>.\u00a0Ref Type: Internet Communication.<\/span><\/div>\n
5.\u00a0Mayo Clinic. Mayo Medical Laboratories. Test Catalog: PM-Scl Antibody. www.mayomedicallaboratories.com<\/a>.\u00a0Ref Type: Internet Communication.<\/span><\/div>\n
6. Rudolf Mierau, Ekkehard Genth. Autoantibodies in Systemic Rheumatic Diseases. In Clinical Laboratory Diagnostics-Use and\u00a0<\/em>Assessment of Clinical Laboratory Results.<\/em> Lothar Thomas. TH-Books Verlagsgesellschaft mbH, Frankfurt \/Main, Germany,1 ed.\u00a01998, 831-832.<\/span><\/div>\n
7. Ruxandra Ionescu. Boli inflamatoare musculare. \u00cen Esen\u0163ialul \u00een Reumatologie<\/em>, Editura Amaltea, 2007, 399-408.<\/span><\/div>","protected":false},"excerpt":{"rendered":"

\u0414\u0435\u0440\u043c\u0430\u0442\u043e\u043c\u0438\u043e\u0437\u0438\u0442, \u043f\u043e\u043b\u0438\u043c\u0438\u043e\u0437\u0438\u0442 \u0438 \u043c\u0438\u043e\u0437\u0438\u0442 \u0441 \u0432\u043a\u043b\u044e\u0447\u0435\u043d\u0438\u044f\u043c\u0438 \u0441\u043e\u0441\u0442\u0430\u0432\u043b\u044f\u044e\u0442 \u0433\u0440\u0443\u043f\u043f\u0443 \u0432\u043e\u0441\u043f\u0430\u043b\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u0445 \u043c\u0438\u043e\u043f\u0430\u0442\u0438\u0439, \u043a\u043e\u0442\u043e\u0440\u044b\u0435 \u0445\u0430\u0440\u0430\u043a\u0442\u0435\u0440\u0438\u0437\u0443\u044e\u0442\u0441\u044f \u0446\u0438\u0442\u043e\u0442\u043e\u043a\u0441\u0438\u0447\u0435\u0441\u043a\u0438\u043c \u043e\u0442\u0432\u0435\u0442\u043e\u043c \u0432 \u043e\u0442\u043d\u043e\u0448\u0435\u043d\u0438\u0438 \u043a\u043e\u043c\u043f\u043e\u043d\u0435\u043d\u0442\u043e\u0432 \u043f\u043e\u043f\u0435\u0440\u0435\u0447\u043d\u043e-\u043f\u043e\u043b\u043e\u0441\u0430\u0442\u043e\u0439 \u043c\u0443\u0441\u043a\u0443\u043b\u0430\u0442\u0443\u0440\u044b. \u0412\u0441\u0435 \u044d\u0442\u0438 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f \u0441\u043e\u043f\u0440\u043e\u0432\u043e\u0436\u0434\u0430\u044e\u0442\u0441\u044f \u043c\u044b\u0448\u0435\u0447\u043d\u043e\u0439 \u0441\u043b\u0430\u0431\u043e\u0441\u0442\u044c\u044e, \u043e\u0442\u0435\u043a\u043e\u043c \u0438 \u0431\u043e\u043b\u044f\u043c\u0438 \u0432\u043e\u0432\u043b\u0435\u0447\u0435\u043d\u043d\u044b\u0445 \u043c\u044b\u0448\u0446, \u043d\u0430 \u0444\u043e\u043d\u0435 \u043a\u043e\u0442\u043e\u0440\u044b\u0445 \u043c\u043e\u0436\u0435\u0442 \u043f\u0440\u0438\u0441\u0443\u0442\u0441\u0442\u0432\u043e\u0432\u0430\u0442\u044c \u0434\u0440\u0443\u0433\u0430\u044f \u0441\u0438\u043c\u043f\u0442\u043e\u043c\u0430\u0442\u0438\u043a\u0430, \u0432 \u0447\u0430\u0441\u0442\u043d\u043e\u0441\u0442\u0438 \u0432\u043e\u0432\u043b\u0435\u0447\u0435\u043d\u0438\u0435 \u043a\u043e\u0436\u0438, \u0430\u043b\u044c\u0432\u0435\u043e\u043b\u0438\u0442 \u0438 \u043b\u0435\u0433\u043e\u0447\u043d\u044b\u0439 \u0444\u0438\u0431\u0440\u043e\u0437, \u043f\u043e\u043b\u0438\u0441\u0438\u043d\u043e\u0432\u0438\u0442 \u0438 \u0440\u044f\u0434 \u0434\u0440\u0443\u0433\u0438\u0445 \u0441\u0438\u043c\u043f\u0442\u043e\u043c\u043e\u0432 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u0439 \u0441\u043e\u0435\u0434\u0438\u043d\u0438\u0442\u0435\u043b\u044c\u043d\u043e\u0439 \u0442\u043a\u0430\u043d\u0438.<\/p>\n

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\u041e\u0441\u043d\u043e\u0432\u043d\u044b\u043c\u0438 \u043b\u0430\u0431\u043e\u0440\u0430\u0442\u043e\u0440\u043d\u044b\u043c\u0438 \u043c\u0430\u0440\u043a\u0435\u0440\u0430\u043c\u0438 \u0432\u043e\u0441\u043f\u0430\u043b\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u0445 \u043c\u0438\u043e\u043f\u0430\u0442\u0438\u0439 \u044f\u0432\u043b\u044f\u044e\u0442\u0441\u044f \u043a\u0440\u0435\u0430\u0442\u0438\u043d\u043a\u0438\u043d\u0430\u0437\u0430, \u0442\u0440\u0430\u043d\u0441\u0430\u043c\u0438\u043d\u0430\u0437\u044b (\u0410\u0421\u0422 \u0438 \u0410\u041b\u0422), \u043c\u0438\u043e\u0433\u043b\u043e\u0431\u0438\u043d. \u0411\u0438\u043e\u0445\u0438\u043c\u0438\u0447\u0435\u0441\u043a\u043e\u0435 \u043e\u0431\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435 \u043f\u043e\u0434\u0442\u0432\u0435\u0440\u0436\u0434\u0430\u0435\u0442 \u0444\u0430\u043a\u0442 \u043c\u0438\u043e\u043b\u0438\u0437\u0430 (\u0440\u0430\u0437\u0440\u0443\u0448\u0435\u043d\u0438\u044f \u043c\u044b\u0448\u0446\u044b) \u0438 \u043f\u0440\u0438\u043c\u0435\u043d\u044f\u0435\u0442\u0441\u044f \u0432 \u0446\u0435\u043b\u044f\u0445 \u043e\u043f\u0440\u0435\u0434\u0435\u043b\u0435\u043d\u0438\u044f \u043f\u043e\u043a\u0430\u0437\u0430\u043d\u0438\u0439 \u043a \u0443\u0433\u043b\u0443\u0431\u043b\u0435\u043d\u043d\u043e\u043c\u0443 \u043e\u0431\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044e.<\/p>\n

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\u041f\u0440\u0435\u0434\u043f\u043e\u0447\u0442\u0438\u0442\u0435\u043b\u044c\u043d\u043e \u0432\u044b\u0434\u0435\u0440\u0436\u0430\u0442\u044c 4 \u0447\u0430\u0441\u0430 \u043f\u043e\u0441\u043b\u0435 \u043f\u043e\u0441\u043b\u0435\u0434\u043d\u0435\u0433\u043e \u043f\u0440\u0438\u0435\u043c\u0430 \u043f\u0438\u0449\u0438, \u043e\u0431\u044f\u0437\u0430\u0442\u0435\u043b\u044c\u043d\u044b\u0445 \u0442\u0440\u0435\u0431\u043e\u0432\u0430\u043d\u0438\u0439 \u043d\u0435\u0442.<\/p>","protected":false},"featured_media":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"product_brand":[],"product_cat":[928,929],"product_tag":[],"class_list":{"0":"post-10023","1":"product","2":"type-product","3":"status-publish","5":"product_cat-markeri-boli-autoimune","6":"product_cat-markeri-pentru-afectiuni-reumatismale-si-vasculite","8":"first","9":"instock","10":"sold-individually","11":"shipping-taxable","12":"purchasable","13":"product-type-simple"},"_links":{"self":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product\/10023","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/comments?post=10023"}],"wp:attachment":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media?parent=10023"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_brand?post=10023"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_cat?post=10023"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_tag?post=10023"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}