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algunos de los cuales son ant&#237;genos espec&#237;ficos&#46; Los patrones m&#225;s comunes son el homog&#233;neo&#44; moteado fino&#44; moteado grueso&#44; nucleolar&#44; citoplasm&#225;tico y centrom&#233;rico&#46; Como patrones menos comunes existen pleom&#243;rfico&#44; m&#250;ltiples puntos nucleares &#40;MND&#41;&#44; centrosoma&#44; NuMA y membrana nuclear&#44; aunque con frecuencia en el suero de determinados pacientes podemos encontrar diferentes autoanticuerpos que resultan en patr&#243;n mixto<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a>&#46; El t&#237;tulo de la concentraci&#243;n de ANA se obtiene tras diluciones sucesivas&#44; con regulador de fosfato&#44; de suero del paciente fijado al sustrato c&#233;lulas HEp-2&#44; al que se le a&#241;ade un anticuerpo policlonal contra inmunoglobulinas humanas marcado con fluoresce&#237;na<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a>&#46; Aunque cada laboratorio debe establecer su propio punto de corte&#44; se recomienda realizar la prueba de cribado con una diluci&#243;n &#62;<span class="elsevierStyleHsp" style=""></span>1&#47;160<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#44;9</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Una de las grandes limitaciones de la IFI es su falta de especificidad&#44; con un valor predictivo positivo &#40;VPP&#41; bajo&#46; En la poblaci&#243;n general la prueba de ANA resulta positiva hasta un 25-30&#37; seg&#250;n distintos estudios&#44; la mayor&#237;a a t&#237;tulos bajos&#44; aunque un 5&#37; pueden presentar t&#237;tulos &#62;<span class="elsevierStyleHsp" style=""></span>1&#47;160<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">10&#44;11</span></a>&#46; Esta prueba se encuentra positiva con mayor frecuencia en personas mayores de 65 a&#241;os &#40;con predominio en mujeres&#41; y en pacientes con infecciones&#44; s&#237;ndromes neurol&#243;gicos paraneopl&#225;sicos&#44; enfermedades hep&#225;ticas&#44; s&#237;ndrome de fatiga cr&#243;nica y neoplasias<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;12</span></a>&#46; El valor predictivo negativo de la prueba s&#237; es elevado en determinadas conectivopat&#237;as&#44; entre las que encontramos principalmente el LES&#44; s&#237;ndrome de Sj&#246;gren&#44; esclerosis sist&#233;mica y miopat&#237;a inflamatoria&#46; Actualmente es una t&#233;cnica de uso com&#250;n en los laboratorios de inmunolog&#237;a&#44; que permite predecir&#44; diagnosticar y determinar la actividad de muchas enfermedades<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;8-10</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Por este motivo&#44; se propone un estudio con el objetivo de determinar los niveles en los t&#237;tulos de ANA observados por IFI en la primera muestra solicitada a un paciente por la Unidad de Reumatolog&#237;a de nuestro hospital&#44; y estudiar su asociaci&#243;n con el diagn&#243;stico de enfermedad del tejido conectivo sist&#233;mica&#44; los distintos patrones observados y las especificidades antig&#233;nicas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todo</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudio prospectivo de muestras sangu&#237;neas de pacientes remitidas a un hospital de segundo nivel para determinar la asociaci&#243;n entre los t&#237;tulos de ANA y el desarrollo de enfermedad sist&#233;mica del tejido conectivo&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Sujetos y muestras</span><p id="par0035" class="elsevierStylePara elsevierViewall">Se seleccionaron las muestras recibidas en el Departamento de Inmunolog&#237;a del Servicio de Hematolog&#237;a del Hospital de Jerez y solicitadas desde la Unidad de Reumatolog&#237;a entre enero del 2010 y diciembre del 2012&#44; pertenecientes a sujetos sin diagn&#243;stico cl&#237;nico a los que no se hubiera realizado con anterioridad la prueba de ANA&#46; Nuestro hospital es un centro de segundo nivel con 550 camas y una Secci&#243;n de Reumatolog&#237;a que atiende a una poblaci&#243;n de 450&#46;000 personas&#44; con una media de valoraci&#243;n en consultas externas de 1&#46;550 pacientes al mes&#44; actividad desarrollada por seis reumat&#243;logos&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Estudios de laboratorio</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se recogi&#243; la primera muestra y se registraron los resultados positivos y negativos de la prueba&#46; Las muestras fueron analizadas por IFI mediante sustrato de la l&#237;nea celular HEp-2 &#40;Euroimmun&#44; Alemania&#41;&#44; y se registr&#243; su nivel de titulaci&#243;n y patr&#243;n&#46; Para aquellos pacientes con ANA a t&#237;tulos mayores a 1&#47;40 se realizaron diluciones a 1&#47;80&#44; 1&#47;160&#44; 1&#47;320&#44; 1&#47;640 y 1&#47;1&#46;280&#46; Cuando la muestra present&#243; mitosis positivas en las c&#233;lulas Hep2&#44; se realiz&#243; la prueba de cribado para la presencia de anticuerpos frente a dsDNA&#44; mediante IFI en Crithidia luciliae &#40;Euroimmun&#44; Alemania&#41;&#46; Si esta era positiva&#44; se cuantificaba la titulaci&#243;n por quimioluminiscencia &#40;Menarini&#44; Italia&#41;&#46; Por otra parte&#44; en todos los casos positivos para el ANA se les aplic&#243; el test ENAs por inmunoblot&#44; mediante el kit comercial EUROLINE ANA Profile 5 &#40;IgG&#41; &#40;Euroimmun&#44; Alemania&#41;&#46; Este kit proporciona un ensayo cualitativo in vitro para autoanticuerpos humanos de la clase IgG frente a 18 ant&#237;genos diferentes&#58; RNP-70&#44; RNP-A&#44; RNP-C&#44; Ro-52&#44; Ro-60&#44; La&#47;SSB&#44; Scl-70&#44; Sm&#44; complejo U1-Nrnp&#44; nucleosoma&#44; Jo-1&#44; Pm-Scl&#44; CENP B&#44; PCNA&#44; dsDNA de doble cadena&#44; histonas&#44; P-prote&#237;na ribosomal y Mi-2 en suero o plasma &#40;sensibilidad y especificidad de los principales ant&#237;genos mostrados en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Las pruebas inmunol&#243;gicas fueron analizadas por un solo inmun&#243;logo entrenado en IFI y pruebas de enzimoinmunoensayo&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Variables y definiciones operativas</span><p id="par0045" class="elsevierStylePara elsevierViewall">Se recogieron variables sociodemogr&#225;ficas &#40;edad y sexo&#41;&#44; de diagn&#243;stico&#44; t&#237;tulo de diluci&#243;n&#44; patr&#243;n por IFI y especificidades antig&#233;nicas de estos pacientes con resultado de su primera prueba positivo&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">El diagn&#243;stico cl&#237;nico de los pacientes se revis&#243; en febrero del 2015&#44; con un m&#237;nimo de dos a&#241;os desde la determinaci&#243;n anal&#237;tica&#46; Para ello se utiliz&#243; el programa inform&#225;tico de historias cl&#237;nicas Diraya&#44; implantado en el Sistema Andaluz de Salud&#46; Se clasificaron los pacientes en dos grupos en funci&#243;n de si hab&#237;an desarrollado enfermedad sist&#233;mica del tejido conectivo o no&#46; La clasificaci&#243;n de enfermedades del tejido conectivo se bas&#243; en el abordaje cl&#225;sico de la <span class="elsevierStyleItalic">American College of Rheumatology</span> adaptado a la actualidad&#44; y que se usa en gran parte de los manuales de nuestra especialidad<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">13</span></a>&#46; Se consideraron conectivopat&#237;as sist&#233;micas&#58; LES&#44; s&#237;ndrome de Sj&#246;gren&#44; esclerosis sist&#233;mica&#44; conectivopat&#237;a indiferenciada&#44; s&#237;ndrome antifosfol&#237;pido&#44; enfermedad mixta del tejido conectivo y miopat&#237;a inflamatoria&#46; Esta informaci&#243;n fue registrada de forma retrospectiva por cuatro reumat&#243;logos de la Unidad de Reumatolog&#237;a del Hospital de Jerez&#44; utilizando las mismas definiciones y entrenados en la recogida de datos de las historias cl&#237;nicas&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">An&#225;lisis estad&#237;stico</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo de las variables cualitativas expres&#225;ndose en frecuencias absolutas y relativas&#44; y de las variables cuantitativas con distribuci&#243;n normal mediante media y desviaci&#243;n est&#225;ndar&#44; mientras que aquellas que no siguieron una distribuci&#243;n normal se expresaron en medianas y rango intercuart&#237;lico &#40;RI&#58; p25-p75&#41;&#46; La edad se analiz&#243; como variable cuantitativa y cualitativa estableciendo como punto de corte 65 a&#241;os&#46; Para la valoraci&#243;n de la distribuci&#243;n normal se desarroll&#243; el test de Kolmogorov-Smirnov&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis estratificado&#44; seg&#250;n presentara diagn&#243;stico cl&#237;nico de conectivopat&#237;a sist&#233;mica o no&#44; utilizando la prueba de chi cuadrado para la comparaci&#243;n entre variables cualitativas de los grupos como los tipos de patrones por IFI y los distintos anticuerpos en tablas de 2<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2&#46; La media de edad entre los grupos se calcul&#243; mediante la t de Student&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Para analizar la asociaci&#243;n entre los t&#237;tulos de ANA y el desarrollo de conectivopat&#237;a sist&#233;mica se construy&#243; un modelo de regresi&#243;n log&#237;stica para calcular la odds ratio &#40;OR&#41;&#44; junto con el intervalo de confianza al 95&#37; &#40;IC 95&#37;&#41; ajustado por potenciales factores de confusi&#243;n&#46; La variable dependiente fue conectivopat&#237;a &#40;s&#237;&#47;no&#41; y las variables independientes se seleccionaron seg&#250;n criterio cl&#237;nico y criterio estad&#237;stico a partir de aquellas con un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;20 en el an&#225;lisis bivariante&#46; El modelo final se ajust&#243; por todas las potenciales variables confusoras&#44; explor&#225;ndose la multicolinealidad entre ellas&#46; La precisi&#243;n del modelo fue analizada mediante el &#225;rea bajo la curva ROC&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Todos los test fueron desarrollados por el programa estad&#237;stico SPSS versi&#243;n 16&#44; asumiendo una significaci&#243;n estad&#237;stica de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados</span><p id="par0075" class="elsevierStylePara elsevierViewall">El Departamento de Inmunolog&#237;a recibi&#243; un total de 9&#46;478 muestras en este periodo&#44; de las cuales un 25&#44;5&#37; &#40;2&#46;426&#41; fueron solicitadas por la Unidad de Reumatolog&#237;a&#44; con un 39&#44;7&#37; &#40;965&#41; de resultados positivos que correspond&#237;an a 576 pacientes &#40;85&#37; mujeres&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Las muestras pertenecientes a pacientes que acud&#237;an por primera vez a valoraci&#243;n en consulta de reumatolog&#237;a y que no ten&#237;an prueba de ANA previa resultaron un total de 1&#46;282&#46; De ellas&#44; 293 &#40;22&#44;8&#37;&#41; presentaron un resultado positivo&#44; con predominio de mujeres &#40;81&#44;9&#37;&#41; y con una media de edad de 47&#44;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;7 a&#241;os&#44; 247 &#40;84&#44;8&#37;&#41; menores de 65 a&#241;os&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">En la distribuci&#243;n por patolog&#237;as de estas primeras muestras positivas de nuestros pacientes&#44; 105 &#40;35&#44;9&#37;&#41; se clasificaron en el grupo de conectivopat&#237;as sist&#233;micas y 188 &#40;64&#44;1&#37;&#41; fueron pacientes sin estas enfermedades&#46; Dentro del grupo de conectivopat&#237;as sist&#233;micas los principales diagn&#243;sticos resultaron&#58; LES en 38 pacientes con VPP de 12&#44;9&#37;&#44; seguido del s&#237;ndrome de Sj&#246;gren en 29 &#40;VPP 9&#44;8&#37;&#41;&#44; esclerosis sist&#233;mica en 17 &#40;VPP 5&#44;8&#37;&#41;&#44; y conectivopat&#237;a indiferenciada en 14 &#40;VPP 4&#44;7&#37;&#41;&#46; Dentro del grupo de pacientes sin conectivopat&#237;as sist&#233;micas las principales patolog&#237;as que encontramos fueron&#58; 26 pacientes con artritis reumatoide &#40;2 asociada a s&#237;ndrome de Sj&#246;gren&#41;&#44; 14 espondiloartropat&#237;as &#40;10 artropat&#237;as psori&#225;sicas&#41;&#44; 13 fibromialgias&#44; 10 artrosis&#44; 9 lupus discoides y 5 microcristalinas&#46; En el momento de revisi&#243;n de los diagn&#243;sticos&#44; 10 pacientes se encontraban en estudio y 30 pacientes no ten&#237;an ninguna enfermedad reum&#225;tica&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Los principales patrones observados en sujetos sin este grupo de conectivopat&#237;as fueron el homog&#233;neo &#40;44&#44;6&#37;&#41;&#44; seguido del moteado fino &#40;34&#44;6&#37;&#41;&#44; y en pacientes con conectivopat&#237;as sist&#233;micas&#44; el moteado fino &#40;44&#44;7&#37;&#41; y el homog&#233;neo &#40;28&#44;5&#37;&#41;&#46; No se observ&#243; ning&#250;n sujeto con patr&#243;n moteado grueso ni PCNA&#46; Las principales especificidades antig&#233;nicas fueron anti-Ro52&#44; anti-Ro60&#44; anti-dsDNA y anti-La&#44; sin positividad para topoisomerasa&#44; anti-Jo1&#44; ni antim&#250;sculo liso &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">En el an&#225;lisis del VPP de las distintas patolog&#237;as seg&#250;n su nivel de titulaci&#243;n se observ&#243; un valor m&#225;s elevado en pacientes con diagn&#243;stico de enfermedades sist&#233;micas del tejido conectivo&#46; As&#237;&#44; para titulaciones 1&#47;640 el grupo de las conectivopat&#237;as present&#243; un VPP de 73&#44;3&#37;&#44; frente al 26&#44;6&#37; de las no conectivopat&#237;as&#44; y para &#8805;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#46;280 un VPP de 85&#37; y 15&#37; respectivamente&#44; diferencias que se mantuvieron al desglosar los sujetos por edades &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Al realizar el an&#225;lisis multivariante se observ&#243; una asociaci&#243;n positiva entre las enfermedades sist&#233;micas del tejido conectivo y las diluciones 1&#47;320 OR 3&#44;069 &#40;IC 95&#37;&#58; 1&#44;237-7&#44;614&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41;&#59; 1&#47;640 OR 12&#44;570 &#40;IC 95&#37;&#58; 3&#44;659-43&#44;187&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#41;&#44; y &#8805;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#46;280 OR 42&#44;136 &#40;IC 95&#37;&#58; 8&#44;604-206&#44;345&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; La evaluaci&#243;n discriminativa de la prueba diagn&#243;stica mediante el &#225;rea bajo la curva ROC present&#243; un valor de 0&#44;749&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discusi&#243;n</span><p id="par0105" class="elsevierStylePara elsevierViewall">Los hallazgos obtenidos en este trabajo muestran asociaci&#243;n entre la presencia de patolog&#237;as reumatol&#243;gicas clasificadas dentro del grupo de las conectivopat&#237;as sist&#233;micas y los niveles m&#225;s altos de titulaciones de la prueba de ANA positiva ya desde su primer an&#225;lisis&#44; en comparaci&#243;n con el grupo de pacientes sin este tipo de enfermedad&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">La utilidad de esta prueba en las enfermedades del tejido conectivo y poblaci&#243;n sana ha sido ampliamente estudiada&#44; estableci&#233;ndose en recientes trabajos gu&#237;as para su uso<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">14&#44;15</span></a>&#46; Sin embargo&#44; son escasos los estudios desarrollados exclusivamente con pacientes valorados en una Unidad de Reumatolog&#237;a y que nunca antes hab&#237;an sido analizados para esta prueba inmunol&#243;gica<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">16</span></a>&#46; As&#237;&#44; en nuestra cohorte presentamos los datos cl&#237;nicos e inmunol&#243;gicos asociados a la prueba de ANA positiva de las primeras muestras solicitadas por un Servicio de Reumatolog&#237;a de un hospital de especialidades en Andaluc&#237;a&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Entre los diagn&#243;sticos observados encontramos un numeroso grupo de sujetos&#44; 158 &#40;56&#44;6&#37;&#41;&#44; sin conectivopat&#237;as sist&#233;micas que presentaron esta primera prueba de ANA positiva&#44; y dentro de este hasta 30 sujetos sin enfermedad reumatol&#243;gica&#46; Distintos trabajos realizados en poblaciones diferentes a la de nuestro estudio muestran una considerable proporci&#243;n de pruebas positivas en sujetos sanos<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#44;17&#44;18</span></a>&#46; Esto podr&#237;a justificarse por dos motivos principales&#58; el elevado n&#250;mero de este tipo de patolog&#237;as que acuden a las consultas de reumatolog&#237;a en Espa&#241;a&#44; donde las conectivopat&#237;as solo representan el 19&#37; de las revisiones en consulta<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a>&#44; y el inicio insidioso de patolog&#237;as reumatol&#243;gicas que pueden en su comienzo simular patolog&#237;as del tejido conectivo&#44; con la conocida positividad de la prueba en enfermedades como artropat&#237;a psori&#225;sica&#44; artritis reumatoide y fibromialgia<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;20-22</span></a>&#46; Dentro de los pacientes a los que realizamos la prueba de ANA atendidos por primera vez en reumatolog&#237;a&#44; un destacable n&#250;mero de ellos&#44; 989 &#40;77&#44;1&#37;&#41;&#44; presentaron un resultado negativo&#46; Este dato puede resultar llamativo en una serie de pruebas solicitadas por especialistas en reumatolog&#237;a&#46; Sin embargo&#44; en una revisi&#243;n de la literatura&#44; nuestras cifras &#40;positividad para el 28&#44;1&#37; de las muestras&#41; son incluso discretamente superiores a estudios realizados por Unidades de Reumatolog&#237;a de hospitales secundarios y terciarios&#44; que presentan datos de prueba de ANA positiva cercanos al 15 y 20&#37; respectivamente&#44; y a&#250;n mayor si los comparamos con otras especialidades m&#233;dicas<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Respecto a los t&#237;tulos de diluciones para la prueba de ANA que presentan enfermedades reumatol&#243;gicas no clasificadas como conectivopat&#237;as sist&#233;micas&#44; y los observados en sujetos sanos&#44; son m&#225;s bajos que en aquellos pacientes con enfermedad sist&#233;mica del tejido conectivo<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#44;18&#44;24</span></a>&#46; En los distintos estudios realizados sobre la utilidad de la prueba de ANA en la poblaci&#243;n general&#44; diluciones &#62;<span class="elsevierStyleHsp" style=""></span>1&#47;160 establecieron el valor a partir del cual existe mayor frecuencia en la asociaci&#243;n con estas conectivopat&#237;as de afectaci&#243;n multiorg&#225;nica<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;25&#44;26</span></a>&#46; En el an&#225;lisis de nuestros resultados se muestra asociaci&#243;n entre diluciones &#62;<span class="elsevierStyleHsp" style=""></span>1&#47;320 y la patolog&#237;a conectiva sist&#233;mica de nuestras consultas&#44; valores que aumentan de forma marcada con mayores diluciones &#40;1&#47;640 y &#62;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#46;280&#41;&#46; De esta forma se establece para nuestra serie una mayor probabilidad de presentar conectivopat&#237;a sist&#233;mica en aquellos pacientes con diluciones m&#225;s altas ya desde su primera visita&#46; Y estos valores mantienen la diferencia con la artritis reumatoide&#44; enfermedad de naturaleza autoinmune que presenta mayor n&#250;mero de pacientes entre sus muestras positivas para t&#237;tulos &#60;<span class="elsevierStyleHsp" style=""></span>1&#47;160&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">En una comparaci&#243;n de este nivel de titulaciones para la prueba de ANA en nuestra Unidad de Reumatolog&#237;a con estudios previos desarrollados por otras especialidades m&#233;dicas se muestra un VPP en las conectivopat&#237;as notablemente superior&#44; tanto en las diluciones m&#225;s bajas &#40;&#62;<span class="elsevierStyleHsp" style=""></span>1&#47;80<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36&#37; vs&#46; 10&#37;&#41;&#44; como para diluciones altas &#40;&#62;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#46;280<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>85&#37; vs&#46; 38&#44;9&#37;&#41;&#46; Y estas diferencias se hacen a&#250;n m&#225;s importantes en el subestudio para LES&#44; donde el VPP es del 12&#44;9&#37; en una diluci&#243;n &#62;<span class="elsevierStyleHsp" style=""></span>1&#47;80 y del 30&#37; para &#62;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#46;280 &#40;vs&#46; 2&#44;2&#37; y 5&#44;6&#37;&#44; respectivamente&#44; en estudio desarrollado por otras especialidades&#41;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La edad tambi&#233;n se ha descrito como un factor importante en la positividad de la prueba&#46; En nuestro trabajo&#44; dentro del grupo de las conectivopat&#237;as sist&#233;micas encontramos un mayor VPP en sujetos menores de 65 a&#241;os&#44; ya que la presentaci&#243;n de estas patolog&#237;as se sit&#250;a con mayor frecuencia en la cuarta y quinta d&#233;cada de la vida&#46; Sin embargo&#44; en las no conectivopat&#237;as&#44; y al clasificar los sujetos en grupos por edad&#44; no encontramos mayor positividad de la prueba para mayores de 65 a&#241;os&#44; como ser&#237;a esperable por la conocida mayor prevalencia del test positivo en sujetos sin conectivopat&#237;as de edad adulta avanzada<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;27</span></a>&#46; Y es adem&#225;s en sujetos mayores de 65 a&#241;os sin conectivopat&#237;as donde se presentan niveles de diluciones m&#225;s elevados<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a>&#44; datos que tampoco se observan en nuestro estudio&#44; donde para este grupo de edad solo 3 pacientes presentaron diluciones 1&#47;320 &#40;VPP 4&#44;6&#37;&#41; y uno 1&#47;640 &#40;VPP 3&#44;3&#37;&#41;&#44; sin observarse ninguna muestra con una diluci&#243;n mayor&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Aunque trabajos previos han asociado mayor significaci&#243;n cl&#237;nica en patrones homog&#233;neos&#44; centrom&#233;rico y citoplasm&#225;tico&#44; en nuestros pacientes con conectivopat&#237;as el patr&#243;n m&#225;s numeroso fue el moteado fino&#44; resultando el VPP de sujetos con patr&#243;n homog&#233;neo y citoplasm&#225;tico sensiblemente menor que en el grupo sin conectivopat&#237;as<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a>&#46; S&#237; existi&#243; un predominio del patr&#243;n centrom&#233;rico con un VPP de 62&#44;5&#37;&#44; que se correspondi&#243; con 7 esclerosis sist&#233;micas&#44; un LES y 2 conectivopat&#237;as indiferenciadas&#46; Adem&#225;s&#44; al contrario que en trabajos recientes publicados que muestran una mayor prevalencia del patr&#243;n moteado fino en sujetos sin este tipo de enfermedades&#44; nuestros datos mostraron un mayor n&#250;mero de sujetos con patr&#243;n homog&#233;neo en las no conectivopat&#237;as sist&#233;micas&#44; con un VPP de 58&#37; frente al 41&#44;9&#37; de las conectivopat&#237;as sist&#233;micas<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;28&#44;29</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">En referencia a los autoanticuerpos&#44; los datos s&#237; se correspondieron con estudios previos<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;16&#44;23</span></a>&#46; La mayor frecuencia se asoci&#243; a anti-Ro52&#44; anti-Ro60&#44; anti-dsDNA y anti-La&#44; con muestras positivas en 44&#44; 35&#44; 17 y 15 pacientes respectivamente&#44; y todos ellos de forma predominante se expresaron como patr&#243;n moteado fino&#44; y en las conectivopat&#237;as sist&#233;micas&#44; con marcada diferencia significativa entre ambos grupos&#46; Debemos destacar que este patr&#243;n en la positividad para anti-Ro52 puede venir determinada por su asociaci&#243;n con anti-Ro60 y&#47;o anti-La&#44; ya que su detecci&#243;n aislada suele presentarse con patr&#243;n citoplasm&#225;tico<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a>&#46; Por &#250;ltimo&#44; los anticuerpos contra dsDNA se pueden encontrar en ocasiones en pacientes con otras enfermedades autoinmunes&#44; infecciosas e incluso en sujetos cl&#237;nicamente asintom&#225;ticos&#44; si bien el 85&#37; de este &#250;ltimo grupo puede desarrollar LES en los cinco a&#241;os posteriores a la positividad para el dsDNA<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a>&#46; En nuestra serie encontramos hasta 3 pacientes con esta prueba positiva &#40;uno con t&#237;tulo 1&#47;320 y dos con 1&#47;640&#41;&#44; que correspondieron a pacientes a&#250;n en estudio que no se hab&#237;an definido a ninguna patolog&#237;a hasta la fecha&#44; pero que habr&#225; que hacer un seguimiento exhaustivo de su evoluci&#243;n&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; todos estos datos muestran el incremento de la frecuencia de ANA en t&#237;tulos elevados observados por IFI desde la primera muestra en enfermedades con conectivopat&#237;as sist&#233;micas respecto a las no conectivopat&#237;as&#44; estableci&#233;ndose esta asociaci&#243;n para diluciones &#62;<span class="elsevierStyleHsp" style=""></span>1&#47;320&#46; El VPP de nuestros pacientes con afectaci&#243;n sist&#233;mica del tejido conectivo es m&#225;s elevado que estudios previos solicitados por otras especialidades m&#233;dicas&#44; ya que una exploraci&#243;n dirigida y el apoyo de otras exploraciones complementarias solicitadas en nuestras consultas conducen a un an&#225;lisis m&#225;s focalizado de la prueba&#46; Aunque en estudios previos&#44; tres a&#241;os desde la positividad de la prueba resultan suficientes para definir la enfermedad hacia patolog&#237;a sist&#233;mica del tejido conectivo o no&#44; nuestro trabajo se ver&#225; mejorado en un posterior an&#225;lisis de los diagn&#243;sticos en aquellos sujetos que clasificados como libres de conectivopat&#237;a sist&#233;mica presentan una alta diluci&#243;n en el t&#237;tulo de ANA&#46; Estudios con mayor n&#250;mero de sujetos aumentar&#225;n la fiabilidad en el an&#225;lisis por grupos de edad y patolog&#237;a espec&#237;fica&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Responsabilidades &#233;ticas</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Protecci&#243;n de personas y animales</span><p id="par0150" class="elsevierStylePara elsevierViewall">Los autores declaran que para esta investigaci&#243;n no se han realizado experimentos en seres humanos ni en animales&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Confidencialidad de los datos</span><p id="par0155" class="elsevierStylePara elsevierViewall">Los autores declaran que han seguido los protocolos de su centro de trabajo sobre la publicaci&#243;n de datos de pacientes&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Derecho a la privacidad y consentimiento informado</span><p id="par0160" class="elsevierStylePara elsevierViewall">Los autores declaran que en este art&#237;culo no aparecen datos de pacientes&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicto de intereses</span><p id="par0165" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Confidencialidad de los datos"
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              "titulo" => "Derecho a la privacidad y consentimiento informado"
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    "resumen" => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Determinar los niveles en los t&#237;tulos de anticuerpos antinucleares &#40;ANA&#41; observados por inmunofluorescencia indirecta en sustrato de c&#233;lula HEp-2&#44; y su asociaci&#243;n con el diagn&#243;stico de enfermedad del tejido conectivo sist&#233;mica en las pruebas solicitadas por una Unidad de Reumatolog&#237;a&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se seleccionaron muestras de pacientes que acud&#237;an por primera vez a consulta de reumatolog&#237;a&#44; sin prueba de ANA previa&#44; durante el periodo comprendido entre enero de 2010 y diciembre de 2012&#46; Se registr&#243; el t&#237;tulo de diluci&#243;n&#44; patr&#243;n y especificidad antig&#233;nica&#46; En enero de 2015 se valoraron los diagn&#243;sticos de los pacientes y se clasificaron en conectivopat&#237;as sist&#233;micas &#40;lupus eritematoso sist&#233;mico&#44; s&#237;ndrome de Sj&#246;gren&#44; esclerosis sist&#233;mica&#44; conectivopat&#237;a indiferenciada&#44; s&#237;ndrome antifosfol&#237;pido&#44; enfermedad mixta del tejido conectivo y miopat&#237;a inflamatoria&#41; o no conectivopat&#237;a sist&#233;mica&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultado</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De un total de 1&#46;282 pruebas solicitadas por la Unidad de Reumatolog&#237;a en sujetos sin estudio previo 293 resultaron positivas&#44; predominando las mujeres &#40;81&#44;9&#37;&#41;&#46; Con conectivopat&#237;a sist&#233;mica se registraron 105 pacientes y 188 sin conectivopat&#237;a&#46; En diluciones 1&#47;640 el valor predictivo positivo en las conectivopat&#237;as fue de 73&#44;3&#37; frente al 26&#44;6&#37; de las no conectivopat&#237;as&#44; y para valores &#8805;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#46;280&#44; 85&#37; frente al 15&#37; respectivamente&#46; Al realizar el an&#225;lisis multivariante se observ&#243; una asociaci&#243;n positiva entre las diluciones 1&#47;320 OR 3&#44;069 &#40;IC 95&#37;&#58; 1&#44;237-7&#44;614&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41;&#44; 1&#47;640 OR 12&#44;570 &#40;IC 95&#37;&#58; 3&#44;659-43&#44;187&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41; y &#8805;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#46;280 OR 42&#44;136 &#40;IC 95&#37;&#58; 8&#44;604-206&#44;345&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estos resultados muestran asociaci&#243;n de t&#237;tulos de diluci&#243;n &#8805;<span class="elsevierStyleHsp" style=""></span>1&#47;320 para la primera prueba de ANA realizada en una Unidad de Reumatolog&#237;a con pacientes con conectivopat&#237;a sist&#233;mica&#46; El VPP en estos pacientes result&#243; superior a estudios previos desarrollados por otras especialidades m&#233;dicas&#46; Esto puede indicar la importancia de una solicitud de la prueba de forma dirigida&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To determine the dilution titles at antinuclear antibodies &#40;ANA&#41; by indirect immunofluorescence observed in cell substrate HEp-2 and its association with the diagnosis of systemic connective tissue disease in ANA test requested by a Rheumatology Unit&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Samples of patients attended for the first time in the rheumatology unit&#44; without prior ANA test&#44; between January 2010 and December 2012 were selected&#46; The dilution titers&#44; immunofluorescence patterns and antigen specificity were recorded&#46; In January 2015 the diagnosis of the patients were evaluated and classified in systemic disease connective tissue &#40;systemic lupus erythematosus&#44; Sj&#246;gren&#39;s syndrome&#44; systemic sclerosis&#44; undifferentiated connective&#44; antiphospholipid syndrome&#44; mixed connective tissue and inflammatory myophaty&#41; or not systemic disease connective tissue&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Result</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A total of 1282 ANA tests requested by the Rheumatology Unit in subjects without previous study&#44; 293 were positive&#44; predominance of women &#40;81&#46;9&#37;&#41;&#46; Patients with systemic connective tissue disease were recorded 105&#44; and 188 without systemic connective tissue disease&#46; For 1&#47;640 dilutions the positive predictive value in the connective was 73&#46;3&#37; compared to 26&#46;6&#37; of non-connective&#44; and for values &#8805;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#44;280 85&#37; versus 15&#37; respectively&#46; When performing the multivariate analysis we observed a positive association between 1&#47;320 dilution OR 3&#46;069 &#40;95&#37; CI&#58; 1&#46;237-7&#46;614&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;016&#41;&#44; 1&#47;640 OR 12&#46;570 &#40;95&#37; CI&#58; 3&#46;659-43&#46;187&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;000&#41; and &#8805;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#44;280 OR 42&#46;136 &#40;95&#37; CI&#58; 8&#46;604-206&#46;345&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;000&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">These results show association titles dilution &#8805;<span class="elsevierStyleHsp" style=""></span>1&#47;320 in ANA&#39;s first test requested by a Rheumatology Unit with patients with systemic connective tissue disease&#46; The VPP in these patients was higher than previous studies requested by other medical specialties&#46; This may indicate the importance of application of the test in a targeted way&#46;</p></span>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anticuerpo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sensibilidad &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Especificidad &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-RNP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-Sm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-SSA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-Ro52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-La&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-Scl70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-Jo1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-centrom&#233;rico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-ribosomal P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-dsDNA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; IFI&#58; inmunofluorescencia indirecta&#59; VPP&#58; valor predictivo positivo&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No conectivopat&#237;as sist&#233;micas</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Conectivopat&#237;as sist&#233;micas</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Pacientes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">188&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#44;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Edad media&#44; a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#44;5 &#40;DE<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#44;9 &#40;DE<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;455&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#44;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#44;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Sexo</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mujeres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">146&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&#44;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hombres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Patr&#243;n IFI</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Homog&#233;neo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Moteado fino</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Citoplasm&#225;tico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;424&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nucleolar</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;572&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Centrom&#233;rico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nuclear dots</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;465&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Membrana nuclear</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mixto</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;675&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ciclo celular</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;454&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Anticuerpos</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-Ro52</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-Ro60</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-La</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-Dna</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-Sm B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-Sm D</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-RNP 70</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-RNPA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-RNPC</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-ribosomal P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;456&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-centrom&#233;rico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-histonas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;259&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-AMA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;098&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-Mi-2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas demogr&#225;ficas e inmunol&#243;gicas de los pacientes incluidos en el estudio</p>"
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        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">AR&#58; artritis reumatoide&#59; IFI&#58; inmunofluorescencia indirecta&#59; LES&#58; lupus eritematoso sist&#233;mico&#59; VPP&#58; valor predictivo positivo&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Conectivopat&#237;as sist&#233;micas</th><th class="td" title="table-head  " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No conectivopat&#237;as sist&#233;micas</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Diluci&#243;n por IFI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#62;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#60;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total conectivopat&#237;as</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#62;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#60;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total no conectivopat&#237;as</th><th class="td" title="table-head  " align="left" valign="top" scope="col">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#47;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#47;160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#47;320&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#47;640&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8805;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#46;280&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1407259.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LES</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">S&#237;ndrome Sj&#246;gren</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Esclerosis sist&#233;mica</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Conectivopat&#237;a indiferenciada</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">AR</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Fibromialgia</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Artrosis</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VVP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#47;80&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#47;160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#47;320&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#47;640&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
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                      "doi" => "10.1136/annrheumdis-2013-203863"
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                  "contribucion" => array:1 [
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Original
Asociación entre títulos de anticuerpos antinucleares y conectivopatías sistémicas en una Unidad de Reumatología
Association between antinuclear antibody titers and connective tissue diseases in a Rheumatology Department
Raúl Menor Almagroa,
Autor para correspondencia
menoralmagro@hotmail.com

Autor para correspondencia.
, Juan Francisco Rodríguez Gutiérrezb, María Auxiliadora Martín-Martínezc, María José Rodríguez Vallsa, Concepción Aranda Valeraa, José Luís de la Iglesia Salgadoa
a Sección de Reumatología, Hospital General de Jerez, Jerez de la Frontera, España
b Servicio de Hematología, Hospital General de Jerez, Jerez de la Frontera, España
c Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Los anticuerpos antinucleares &#40;ANA&#41; son inmunoglobulinas dirigidas contra componentes aut&#243;logos del n&#250;cleo y citoplasma celular<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a>&#46; La prueba de ANA resulta de gran importancia en el diagn&#243;stico de enfermedades autoinmunes sist&#233;micas y &#243;rgano-espec&#237;ficas&#44; y ofrece informaci&#243;n sobre el curso cl&#237;nico y las complicaciones de la enfermedad&#44; pudiendo presentarse desde a&#241;os antes de la aparici&#243;n de los s&#237;ntomas<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La t&#233;cnica est&#225;ndar oro para la detecci&#243;n de ANA es la inmunofluorescencia indirecta &#40;IFI&#41;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; Su utilidad se ha incrementado progresivamente desde que en 1957 se usaron anticuerpos marcados con fluorocromo&#44; para demostrar que el suero de pacientes con lupus eritematoso sist&#233;mico &#40;LES&#41; conten&#237;a anticuerpos que produc&#237;an fluorescencia nuclear homog&#233;nea en tejidos humanos<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">5</span></a>&#46; Actualmente se utilizan como sustrato c&#233;lulas HEp-2 &#40;l&#237;nea celular epitelial humana obtenida de carcinoma de laringe&#41;&#44; que presenta ventajas frente a los sustratos utilizados tradicionalmente &#40;como h&#237;gado y ri&#241;&#243;n de roedores&#41; al expresar ant&#237;genos presentes en todas las fases del ciclo celular<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Se han detectado aproximadamente 100 autoanticuerpos diferentes&#44; describi&#233;ndose m&#225;s de 35 patrones por inmunofluorescencia&#44; algunos de los cuales son ant&#237;genos espec&#237;ficos&#46; Los patrones m&#225;s comunes son el homog&#233;neo&#44; moteado fino&#44; moteado grueso&#44; nucleolar&#44; citoplasm&#225;tico y centrom&#233;rico&#46; Como patrones menos comunes existen pleom&#243;rfico&#44; m&#250;ltiples puntos nucleares &#40;MND&#41;&#44; centrosoma&#44; NuMA y membrana nuclear&#44; aunque con frecuencia en el suero de determinados pacientes podemos encontrar diferentes autoanticuerpos que resultan en patr&#243;n mixto<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a>&#46; El t&#237;tulo de la concentraci&#243;n de ANA se obtiene tras diluciones sucesivas&#44; con regulador de fosfato&#44; de suero del paciente fijado al sustrato c&#233;lulas HEp-2&#44; al que se le a&#241;ade un anticuerpo policlonal contra inmunoglobulinas humanas marcado con fluoresce&#237;na<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a>&#46; Aunque cada laboratorio debe establecer su propio punto de corte&#44; se recomienda realizar la prueba de cribado con una diluci&#243;n &#62;<span class="elsevierStyleHsp" style=""></span>1&#47;160<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#44;9</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Una de las grandes limitaciones de la IFI es su falta de especificidad&#44; con un valor predictivo positivo &#40;VPP&#41; bajo&#46; En la poblaci&#243;n general la prueba de ANA resulta positiva hasta un 25-30&#37; seg&#250;n distintos estudios&#44; la mayor&#237;a a t&#237;tulos bajos&#44; aunque un 5&#37; pueden presentar t&#237;tulos &#62;<span class="elsevierStyleHsp" style=""></span>1&#47;160<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">10&#44;11</span></a>&#46; Esta prueba se encuentra positiva con mayor frecuencia en personas mayores de 65 a&#241;os &#40;con predominio en mujeres&#41; y en pacientes con infecciones&#44; s&#237;ndromes neurol&#243;gicos paraneopl&#225;sicos&#44; enfermedades hep&#225;ticas&#44; s&#237;ndrome de fatiga cr&#243;nica y neoplasias<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;12</span></a>&#46; El valor predictivo negativo de la prueba s&#237; es elevado en determinadas conectivopat&#237;as&#44; entre las que encontramos principalmente el LES&#44; s&#237;ndrome de Sj&#246;gren&#44; esclerosis sist&#233;mica y miopat&#237;a inflamatoria&#46; Actualmente es una t&#233;cnica de uso com&#250;n en los laboratorios de inmunolog&#237;a&#44; que permite predecir&#44; diagnosticar y determinar la actividad de muchas enfermedades<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;8-10</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Por este motivo&#44; se propone un estudio con el objetivo de determinar los niveles en los t&#237;tulos de ANA observados por IFI en la primera muestra solicitada a un paciente por la Unidad de Reumatolog&#237;a de nuestro hospital&#44; y estudiar su asociaci&#243;n con el diagn&#243;stico de enfermedad del tejido conectivo sist&#233;mica&#44; los distintos patrones observados y las especificidades antig&#233;nicas&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todo</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudio prospectivo de muestras sangu&#237;neas de pacientes remitidas a un hospital de segundo nivel para determinar la asociaci&#243;n entre los t&#237;tulos de ANA y el desarrollo de enfermedad sist&#233;mica del tejido conectivo&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Sujetos y muestras</span><p id="par0035" class="elsevierStylePara elsevierViewall">Se seleccionaron las muestras recibidas en el Departamento de Inmunolog&#237;a del Servicio de Hematolog&#237;a del Hospital de Jerez y solicitadas desde la Unidad de Reumatolog&#237;a entre enero del 2010 y diciembre del 2012&#44; pertenecientes a sujetos sin diagn&#243;stico cl&#237;nico a los que no se hubiera realizado con anterioridad la prueba de ANA&#46; Nuestro hospital es un centro de segundo nivel con 550 camas y una Secci&#243;n de Reumatolog&#237;a que atiende a una poblaci&#243;n de 450&#46;000 personas&#44; con una media de valoraci&#243;n en consultas externas de 1&#46;550 pacientes al mes&#44; actividad desarrollada por seis reumat&#243;logos&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Estudios de laboratorio</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se recogi&#243; la primera muestra y se registraron los resultados positivos y negativos de la prueba&#46; Las muestras fueron analizadas por IFI mediante sustrato de la l&#237;nea celular HEp-2 &#40;Euroimmun&#44; Alemania&#41;&#44; y se registr&#243; su nivel de titulaci&#243;n y patr&#243;n&#46; Para aquellos pacientes con ANA a t&#237;tulos mayores a 1&#47;40 se realizaron diluciones a 1&#47;80&#44; 1&#47;160&#44; 1&#47;320&#44; 1&#47;640 y 1&#47;1&#46;280&#46; Cuando la muestra present&#243; mitosis positivas en las c&#233;lulas Hep2&#44; se realiz&#243; la prueba de cribado para la presencia de anticuerpos frente a dsDNA&#44; mediante IFI en Crithidia luciliae &#40;Euroimmun&#44; Alemania&#41;&#46; Si esta era positiva&#44; se cuantificaba la titulaci&#243;n por quimioluminiscencia &#40;Menarini&#44; Italia&#41;&#46; Por otra parte&#44; en todos los casos positivos para el ANA se les aplic&#243; el test ENAs por inmunoblot&#44; mediante el kit comercial EUROLINE ANA Profile 5 &#40;IgG&#41; &#40;Euroimmun&#44; Alemania&#41;&#46; Este kit proporciona un ensayo cualitativo in vitro para autoanticuerpos humanos de la clase IgG frente a 18 ant&#237;genos diferentes&#58; RNP-70&#44; RNP-A&#44; RNP-C&#44; Ro-52&#44; Ro-60&#44; La&#47;SSB&#44; Scl-70&#44; Sm&#44; complejo U1-Nrnp&#44; nucleosoma&#44; Jo-1&#44; Pm-Scl&#44; CENP B&#44; PCNA&#44; dsDNA de doble cadena&#44; histonas&#44; P-prote&#237;na ribosomal y Mi-2 en suero o plasma &#40;sensibilidad y especificidad de los principales ant&#237;genos mostrados en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Las pruebas inmunol&#243;gicas fueron analizadas por un solo inmun&#243;logo entrenado en IFI y pruebas de enzimoinmunoensayo&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Variables y definiciones operativas</span><p id="par0045" class="elsevierStylePara elsevierViewall">Se recogieron variables sociodemogr&#225;ficas &#40;edad y sexo&#41;&#44; de diagn&#243;stico&#44; t&#237;tulo de diluci&#243;n&#44; patr&#243;n por IFI y especificidades antig&#233;nicas de estos pacientes con resultado de su primera prueba positivo&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">El diagn&#243;stico cl&#237;nico de los pacientes se revis&#243; en febrero del 2015&#44; con un m&#237;nimo de dos a&#241;os desde la determinaci&#243;n anal&#237;tica&#46; Para ello se utiliz&#243; el programa inform&#225;tico de historias cl&#237;nicas Diraya&#44; implantado en el Sistema Andaluz de Salud&#46; Se clasificaron los pacientes en dos grupos en funci&#243;n de si hab&#237;an desarrollado enfermedad sist&#233;mica del tejido conectivo o no&#46; La clasificaci&#243;n de enfermedades del tejido conectivo se bas&#243; en el abordaje cl&#225;sico de la <span class="elsevierStyleItalic">American College of Rheumatology</span> adaptado a la actualidad&#44; y que se usa en gran parte de los manuales de nuestra especialidad<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">13</span></a>&#46; Se consideraron conectivopat&#237;as sist&#233;micas&#58; LES&#44; s&#237;ndrome de Sj&#246;gren&#44; esclerosis sist&#233;mica&#44; conectivopat&#237;a indiferenciada&#44; s&#237;ndrome antifosfol&#237;pido&#44; enfermedad mixta del tejido conectivo y miopat&#237;a inflamatoria&#46; Esta informaci&#243;n fue registrada de forma retrospectiva por cuatro reumat&#243;logos de la Unidad de Reumatolog&#237;a del Hospital de Jerez&#44; utilizando las mismas definiciones y entrenados en la recogida de datos de las historias cl&#237;nicas&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">An&#225;lisis estad&#237;stico</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo de las variables cualitativas expres&#225;ndose en frecuencias absolutas y relativas&#44; y de las variables cuantitativas con distribuci&#243;n normal mediante media y desviaci&#243;n est&#225;ndar&#44; mientras que aquellas que no siguieron una distribuci&#243;n normal se expresaron en medianas y rango intercuart&#237;lico &#40;RI&#58; p25-p75&#41;&#46; La edad se analiz&#243; como variable cuantitativa y cualitativa estableciendo como punto de corte 65 a&#241;os&#46; Para la valoraci&#243;n de la distribuci&#243;n normal se desarroll&#243; el test de Kolmogorov-Smirnov&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis estratificado&#44; seg&#250;n presentara diagn&#243;stico cl&#237;nico de conectivopat&#237;a sist&#233;mica o no&#44; utilizando la prueba de chi cuadrado para la comparaci&#243;n entre variables cualitativas de los grupos como los tipos de patrones por IFI y los distintos anticuerpos en tablas de 2<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2&#46; La media de edad entre los grupos se calcul&#243; mediante la t de Student&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Para analizar la asociaci&#243;n entre los t&#237;tulos de ANA y el desarrollo de conectivopat&#237;a sist&#233;mica se construy&#243; un modelo de regresi&#243;n log&#237;stica para calcular la odds ratio &#40;OR&#41;&#44; junto con el intervalo de confianza al 95&#37; &#40;IC 95&#37;&#41; ajustado por potenciales factores de confusi&#243;n&#46; La variable dependiente fue conectivopat&#237;a &#40;s&#237;&#47;no&#41; y las variables independientes se seleccionaron seg&#250;n criterio cl&#237;nico y criterio estad&#237;stico a partir de aquellas con un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;20 en el an&#225;lisis bivariante&#46; El modelo final se ajust&#243; por todas las potenciales variables confusoras&#44; explor&#225;ndose la multicolinealidad entre ellas&#46; La precisi&#243;n del modelo fue analizada mediante el &#225;rea bajo la curva ROC&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Todos los test fueron desarrollados por el programa estad&#237;stico SPSS versi&#243;n 16&#44; asumiendo una significaci&#243;n estad&#237;stica de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados</span><p id="par0075" class="elsevierStylePara elsevierViewall">El Departamento de Inmunolog&#237;a recibi&#243; un total de 9&#46;478 muestras en este periodo&#44; de las cuales un 25&#44;5&#37; &#40;2&#46;426&#41; fueron solicitadas por la Unidad de Reumatolog&#237;a&#44; con un 39&#44;7&#37; &#40;965&#41; 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fueron pacientes sin estas enfermedades&#46; Dentro del grupo de conectivopat&#237;as sist&#233;micas los principales diagn&#243;sticos resultaron&#58; LES en 38 pacientes con VPP de 12&#44;9&#37;&#44; seguido del s&#237;ndrome de Sj&#246;gren en 29 &#40;VPP 9&#44;8&#37;&#41;&#44; esclerosis sist&#233;mica en 17 &#40;VPP 5&#44;8&#37;&#41;&#44; y conectivopat&#237;a indiferenciada en 14 &#40;VPP 4&#44;7&#37;&#41;&#46; Dentro del grupo de pacientes sin conectivopat&#237;as sist&#233;micas las principales patolog&#237;as que encontramos fueron&#58; 26 pacientes con artritis reumatoide &#40;2 asociada a s&#237;ndrome de Sj&#246;gren&#41;&#44; 14 espondiloartropat&#237;as &#40;10 artropat&#237;as psori&#225;sicas&#41;&#44; 13 fibromialgias&#44; 10 artrosis&#44; 9 lupus discoides y 5 microcristalinas&#46; En el momento de revisi&#243;n de los diagn&#243;sticos&#44; 10 pacientes se encontraban en estudio y 30 pacientes no ten&#237;an ninguna enfermedad reum&#225;tica&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Los principales patrones observados en sujetos sin este grupo de conectivopat&#237;as fueron el homog&#233;neo &#40;44&#44;6&#37;&#41;&#44; seguido del moteado fino &#40;34&#44;6&#37;&#41;&#44; y en pacientes con conectivopat&#237;as sist&#233;micas&#44; el moteado fino &#40;44&#44;7&#37;&#41; y el homog&#233;neo &#40;28&#44;5&#37;&#41;&#46; No se observ&#243; ning&#250;n sujeto con patr&#243;n moteado grueso ni PCNA&#46; Las principales especificidades antig&#233;nicas fueron anti-Ro52&#44; anti-Ro60&#44; anti-dsDNA y anti-La&#44; sin positividad para topoisomerasa&#44; anti-Jo1&#44; ni antim&#250;sculo liso &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">En el an&#225;lisis del VPP de las distintas patolog&#237;as seg&#250;n su nivel de titulaci&#243;n se observ&#243; un valor m&#225;s elevado en pacientes con diagn&#243;stico de enfermedades sist&#233;micas del tejido conectivo&#46; As&#237;&#44; para titulaciones 1&#47;640 el grupo de las conectivopat&#237;as present&#243; un VPP de 73&#44;3&#37;&#44; frente al 26&#44;6&#37; de las no conectivopat&#237;as&#44; y para &#8805;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#46;280 un VPP de 85&#37; y 15&#37; respectivamente&#44; diferencias que se mantuvieron al desglosar los sujetos por edades &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Al realizar el an&#225;lisis multivariante se observ&#243; una asociaci&#243;n positiva entre las enfermedades sist&#233;micas del tejido conectivo y las diluciones 1&#47;320 OR 3&#44;069 &#40;IC 95&#37;&#58; 1&#44;237-7&#44;614&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41;&#59; 1&#47;640 OR 12&#44;570 &#40;IC 95&#37;&#58; 3&#44;659-43&#44;187&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#41;&#44; y &#8805;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#46;280 OR 42&#44;136 &#40;IC 95&#37;&#58; 8&#44;604-206&#44;345&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; La evaluaci&#243;n discriminativa de la prueba diagn&#243;stica mediante el &#225;rea bajo la curva ROC present&#243; un valor de 0&#44;749&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discusi&#243;n</span><p id="par0105" class="elsevierStylePara elsevierViewall">Los hallazgos obtenidos en este trabajo muestran asociaci&#243;n entre la presencia de patolog&#237;as reumatol&#243;gicas clasificadas dentro del grupo de las conectivopat&#237;as sist&#233;micas y los niveles m&#225;s altos de titulaciones de la prueba de ANA positiva ya desde su primer an&#225;lisis&#44; en comparaci&#243;n con el grupo de pacientes sin este tipo de enfermedad&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">La utilidad de esta prueba en las enfermedades del tejido conectivo y poblaci&#243;n sana ha sido ampliamente estudiada&#44; estableci&#233;ndose en recientes trabajos gu&#237;as para su uso<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">14&#44;15</span></a>&#46; Sin embargo&#44; son escasos los estudios desarrollados exclusivamente con pacientes valorados en una Unidad de Reumatolog&#237;a y que nunca antes hab&#237;an sido analizados para esta prueba inmunol&#243;gica<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">16</span></a>&#46; As&#237;&#44; en nuestra cohorte presentamos los datos cl&#237;nicos e inmunol&#243;gicos asociados a la prueba de ANA positiva de las primeras muestras solicitadas por un Servicio de Reumatolog&#237;a de un hospital de especialidades en Andaluc&#237;a&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Entre los diagn&#243;sticos observados encontramos un numeroso grupo de sujetos&#44; 158 &#40;56&#44;6&#37;&#41;&#44; sin conectivopat&#237;as sist&#233;micas que presentaron esta primera prueba de ANA positiva&#44; y dentro de este hasta 30 sujetos sin enfermedad reumatol&#243;gica&#46; Distintos trabajos realizados en poblaciones diferentes a la de nuestro estudio muestran una considerable proporci&#243;n de pruebas positivas en sujetos sanos<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#44;17&#44;18</span></a>&#46; Esto podr&#237;a justificarse por dos motivos principales&#58; el elevado n&#250;mero de este tipo de patolog&#237;as que acuden a las consultas de reumatolog&#237;a en Espa&#241;a&#44; donde las conectivopat&#237;as solo representan el 19&#37; de las revisiones en consulta<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a>&#44; y el inicio insidioso de patolog&#237;as reumatol&#243;gicas que pueden en su comienzo simular patolog&#237;as del tejido conectivo&#44; con la conocida positividad de la prueba en enfermedades como artropat&#237;a psori&#225;sica&#44; artritis reumatoide y fibromialgia<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;20-22</span></a>&#46; Dentro de los pacientes a los que realizamos la prueba de ANA atendidos por primera vez en reumatolog&#237;a&#44; un destacable n&#250;mero de ellos&#44; 989 &#40;77&#44;1&#37;&#41;&#44; presentaron un resultado negativo&#46; Este dato puede resultar llamativo en una serie de pruebas solicitadas por especialistas en reumatolog&#237;a&#46; Sin embargo&#44; en una revisi&#243;n de la literatura&#44; nuestras cifras &#40;positividad para el 28&#44;1&#37; de las muestras&#41; son incluso discretamente superiores a estudios realizados por Unidades de Reumatolog&#237;a de hospitales secundarios y terciarios&#44; que presentan datos de prueba de ANA positiva cercanos al 15 y 20&#37; respectivamente&#44; y a&#250;n mayor si los comparamos con otras especialidades m&#233;dicas<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Respecto a los t&#237;tulos de diluciones para la prueba de ANA que presentan enfermedades reumatol&#243;gicas no clasificadas como conectivopat&#237;as sist&#233;micas&#44; y los observados en sujetos sanos&#44; son m&#225;s bajos que en aquellos pacientes con enfermedad sist&#233;mica del tejido conectivo<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#44;18&#44;24</span></a>&#46; En los distintos estudios realizados sobre la utilidad de la prueba de ANA en la poblaci&#243;n general&#44; diluciones &#62;<span class="elsevierStyleHsp" style=""></span>1&#47;160 establecieron el valor a partir del cual existe mayor frecuencia en la asociaci&#243;n con estas conectivopat&#237;as de afectaci&#243;n multiorg&#225;nica<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;25&#44;26</span></a>&#46; En el an&#225;lisis de nuestros resultados se muestra asociaci&#243;n entre diluciones &#62;<span class="elsevierStyleHsp" style=""></span>1&#47;320 y la patolog&#237;a conectiva sist&#233;mica de nuestras consultas&#44; valores que aumentan de forma marcada con mayores diluciones &#40;1&#47;640 y &#62;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#46;280&#41;&#46; De esta forma se establece para nuestra serie una mayor probabilidad de presentar conectivopat&#237;a sist&#233;mica en aquellos pacientes con diluciones m&#225;s altas ya desde su primera visita&#46; Y estos valores mantienen la diferencia con la artritis reumatoide&#44; enfermedad de naturaleza autoinmune que presenta mayor n&#250;mero de pacientes entre sus muestras positivas para t&#237;tulos &#60;<span class="elsevierStyleHsp" style=""></span>1&#47;160&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">En una comparaci&#243;n de este nivel de titulaciones para la prueba de ANA en nuestra Unidad de Reumatolog&#237;a con estudios previos desarrollados por otras especialidades m&#233;dicas se muestra un VPP en las conectivopat&#237;as notablemente superior&#44; tanto en las diluciones m&#225;s bajas &#40;&#62;<span class="elsevierStyleHsp" style=""></span>1&#47;80<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36&#37; vs&#46; 10&#37;&#41;&#44; como para diluciones altas &#40;&#62;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#46;280<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>85&#37; vs&#46; 38&#44;9&#37;&#41;&#46; Y estas diferencias se hacen a&#250;n m&#225;s importantes en el subestudio para LES&#44; donde el VPP es del 12&#44;9&#37; en una diluci&#243;n &#62;<span class="elsevierStyleHsp" style=""></span>1&#47;80 y del 30&#37; para &#62;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#46;280 &#40;vs&#46; 2&#44;2&#37; y 5&#44;6&#37;&#44; respectivamente&#44; en estudio desarrollado por otras especialidades&#41;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La edad tambi&#233;n se ha descrito como un factor importante en la positividad de la prueba&#46; En nuestro trabajo&#44; dentro del grupo de las conectivopat&#237;as sist&#233;micas encontramos un mayor VPP en sujetos menores de 65 a&#241;os&#44; ya que la presentaci&#243;n de estas patolog&#237;as se sit&#250;a con mayor frecuencia en la cuarta y quinta d&#233;cada de la vida&#46; Sin embargo&#44; en las no conectivopat&#237;as&#44; y al clasificar los sujetos en grupos por edad&#44; no encontramos mayor positividad de la prueba para mayores de 65 a&#241;os&#44; como ser&#237;a esperable por la conocida mayor prevalencia del test positivo en sujetos sin conectivopat&#237;as de edad adulta avanzada<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;27</span></a>&#46; Y es adem&#225;s en sujetos mayores de 65 a&#241;os sin conectivopat&#237;as donde se presentan niveles de diluciones m&#225;s elevados<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a>&#44; datos que tampoco se observan en nuestro estudio&#44; donde para este grupo de edad solo 3 pacientes presentaron diluciones 1&#47;320 &#40;VPP 4&#44;6&#37;&#41; y uno 1&#47;640 &#40;VPP 3&#44;3&#37;&#41;&#44; sin observarse ninguna muestra con una diluci&#243;n mayor&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Aunque trabajos previos han asociado mayor significaci&#243;n cl&#237;nica en patrones homog&#233;neos&#44; centrom&#233;rico y citoplasm&#225;tico&#44; en nuestros pacientes con conectivopat&#237;as el patr&#243;n m&#225;s numeroso fue el moteado fino&#44; resultando el VPP de sujetos con patr&#243;n homog&#233;neo y citoplasm&#225;tico sensiblemente menor que en el grupo sin conectivopat&#237;as<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a>&#46; S&#237; existi&#243; un predominio del patr&#243;n centrom&#233;rico con un VPP de 62&#44;5&#37;&#44; que se correspondi&#243; con 7 esclerosis sist&#233;micas&#44; un LES y 2 conectivopat&#237;as indiferenciadas&#46; Adem&#225;s&#44; al contrario que en trabajos recientes publicados que muestran una mayor prevalencia del patr&#243;n moteado fino en sujetos sin este tipo de enfermedades&#44; nuestros datos mostraron un mayor n&#250;mero de sujetos con patr&#243;n homog&#233;neo en las no conectivopat&#237;as sist&#233;micas&#44; con un VPP de 58&#37; frente al 41&#44;9&#37; de las conectivopat&#237;as sist&#233;micas<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;28&#44;29</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">En referencia a los autoanticuerpos&#44; los datos s&#237; se correspondieron con estudios previos<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;16&#44;23</span></a>&#46; La mayor frecuencia se asoci&#243; a anti-Ro52&#44; anti-Ro60&#44; anti-dsDNA y anti-La&#44; con muestras positivas en 44&#44; 35&#44; 17 y 15 pacientes respectivamente&#44; y todos ellos de forma predominante se expresaron como patr&#243;n moteado fino&#44; y en las conectivopat&#237;as sist&#233;micas&#44; con marcada diferencia significativa entre ambos grupos&#46; Debemos destacar que este patr&#243;n en la positividad para anti-Ro52 puede venir determinada por su asociaci&#243;n con anti-Ro60 y&#47;o anti-La&#44; ya que su detecci&#243;n aislada suele presentarse con patr&#243;n citoplasm&#225;tico<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">30</span></a>&#46; Por &#250;ltimo&#44; los anticuerpos contra dsDNA se pueden encontrar en ocasiones en pacientes con otras enfermedades autoinmunes&#44; infecciosas e incluso en sujetos cl&#237;nicamente asintom&#225;ticos&#44; si bien el 85&#37; de este &#250;ltimo grupo puede desarrollar LES en los cinco a&#241;os posteriores a la positividad para el dsDNA<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a>&#46; En nuestra serie encontramos hasta 3 pacientes con esta prueba positiva &#40;uno con t&#237;tulo 1&#47;320 y dos con 1&#47;640&#41;&#44; que correspondieron a pacientes a&#250;n en estudio que no se hab&#237;an definido a ninguna patolog&#237;a hasta la fecha&#44; pero que habr&#225; que hacer un seguimiento exhaustivo de su evoluci&#243;n&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; todos estos datos muestran el incremento de la frecuencia de ANA en t&#237;tulos elevados observados por IFI desde la primera muestra en enfermedades con conectivopat&#237;as sist&#233;micas respecto a las no conectivopat&#237;as&#44; estableci&#233;ndose esta asociaci&#243;n para diluciones &#62;<span class="elsevierStyleHsp" style=""></span>1&#47;320&#46; El VPP de nuestros pacientes con afectaci&#243;n sist&#233;mica del tejido conectivo es m&#225;s elevado que estudios previos solicitados por otras especialidades m&#233;dicas&#44; ya que una exploraci&#243;n dirigida y el apoyo de otras exploraciones complementarias solicitadas en nuestras consultas conducen a un an&#225;lisis m&#225;s focalizado de la prueba&#46; Aunque en estudios previos&#44; tres a&#241;os desde la positividad de la prueba resultan suficientes para definir la enfermedad hacia patolog&#237;a sist&#233;mica del tejido conectivo o no&#44; nuestro trabajo se ver&#225; mejorado en un posterior an&#225;lisis de los diagn&#243;sticos en aquellos sujetos que clasificados como libres de conectivopat&#237;a sist&#233;mica presentan una alta diluci&#243;n en el t&#237;tulo de ANA&#46; Estudios con mayor n&#250;mero de sujetos aumentar&#225;n la fiabilidad en el an&#225;lisis por grupos de edad y patolog&#237;a espec&#237;fica&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Responsabilidades &#233;ticas</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Protecci&#243;n de personas y animales</span><p id="par0150" class="elsevierStylePara elsevierViewall">Los autores declaran que para esta investigaci&#243;n no se han realizado experimentos en seres humanos ni en animales&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Confidencialidad de los datos</span><p id="par0155" class="elsevierStylePara elsevierViewall">Los autores declaran que han seguido los protocolos de su centro de trabajo sobre la publicaci&#243;n de datos de pacientes&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Derecho a la privacidad y consentimiento informado</span><p id="par0160" class="elsevierStylePara elsevierViewall">Los autores declaran que en este art&#237;culo no aparecen datos de pacientes&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicto de intereses</span><p id="par0165" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Determinar los niveles en los t&#237;tulos de anticuerpos antinucleares &#40;ANA&#41; observados por inmunofluorescencia indirecta en sustrato de c&#233;lula HEp-2&#44; y su asociaci&#243;n con el diagn&#243;stico de enfermedad del tejido conectivo sist&#233;mica en las pruebas solicitadas por una Unidad de Reumatolog&#237;a&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se seleccionaron muestras de pacientes que acud&#237;an por primera vez a consulta de reumatolog&#237;a&#44; sin prueba de ANA previa&#44; durante el periodo comprendido entre enero de 2010 y diciembre de 2012&#46; Se registr&#243; el t&#237;tulo de diluci&#243;n&#44; patr&#243;n y especificidad antig&#233;nica&#46; En enero de 2015 se valoraron los diagn&#243;sticos de los pacientes y se clasificaron en conectivopat&#237;as sist&#233;micas &#40;lupus eritematoso sist&#233;mico&#44; s&#237;ndrome de Sj&#246;gren&#44; esclerosis sist&#233;mica&#44; conectivopat&#237;a indiferenciada&#44; s&#237;ndrome antifosfol&#237;pido&#44; enfermedad mixta del tejido conectivo y miopat&#237;a inflamatoria&#41; o no conectivopat&#237;a sist&#233;mica&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultado</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De un total de 1&#46;282 pruebas solicitadas por la Unidad de Reumatolog&#237;a en sujetos sin estudio previo 293 resultaron positivas&#44; predominando las mujeres &#40;81&#44;9&#37;&#41;&#46; Con conectivopat&#237;a sist&#233;mica se registraron 105 pacientes y 188 sin conectivopat&#237;a&#46; En diluciones 1&#47;640 el valor predictivo positivo en las conectivopat&#237;as fue de 73&#44;3&#37; frente al 26&#44;6&#37; de las no conectivopat&#237;as&#44; y para valores &#8805;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#46;280&#44; 85&#37; frente al 15&#37; respectivamente&#46; Al realizar el an&#225;lisis multivariante se observ&#243; una asociaci&#243;n positiva entre las diluciones 1&#47;320 OR 3&#44;069 &#40;IC 95&#37;&#58; 1&#44;237-7&#44;614&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41;&#44; 1&#47;640 OR 12&#44;570 &#40;IC 95&#37;&#58; 3&#44;659-43&#44;187&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41; y &#8805;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#46;280 OR 42&#44;136 &#40;IC 95&#37;&#58; 8&#44;604-206&#44;345&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estos resultados muestran asociaci&#243;n de t&#237;tulos de diluci&#243;n &#8805;<span class="elsevierStyleHsp" style=""></span>1&#47;320 para la primera prueba de ANA realizada en una Unidad de Reumatolog&#237;a con pacientes con conectivopat&#237;a sist&#233;mica&#46; El VPP en estos pacientes result&#243; superior a estudios previos desarrollados por otras especialidades m&#233;dicas&#46; Esto puede indicar la importancia de una solicitud de la prueba de forma dirigida&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultado"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To determine the dilution titles at antinuclear antibodies &#40;ANA&#41; by indirect immunofluorescence observed in cell substrate HEp-2 and its association with the diagnosis of systemic connective tissue disease in ANA test requested by a Rheumatology Unit&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Samples of patients attended for the first time in the rheumatology unit&#44; without prior ANA test&#44; between January 2010 and December 2012 were selected&#46; The dilution titers&#44; immunofluorescence patterns and antigen specificity were recorded&#46; In January 2015 the diagnosis of the patients were evaluated and classified in systemic disease connective tissue &#40;systemic lupus erythematosus&#44; Sj&#246;gren&#39;s syndrome&#44; systemic sclerosis&#44; undifferentiated connective&#44; antiphospholipid syndrome&#44; mixed connective tissue and inflammatory myophaty&#41; or not systemic disease connective tissue&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Result</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A total of 1282 ANA tests requested by the Rheumatology Unit in subjects without previous study&#44; 293 were positive&#44; predominance of women &#40;81&#46;9&#37;&#41;&#46; Patients with systemic connective tissue disease were recorded 105&#44; and 188 without systemic connective tissue disease&#46; For 1&#47;640 dilutions the positive predictive value in the connective was 73&#46;3&#37; compared to 26&#46;6&#37; of non-connective&#44; and for values &#8805;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#44;280 85&#37; versus 15&#37; respectively&#46; When performing the multivariate analysis we observed a positive association between 1&#47;320 dilution OR 3&#46;069 &#40;95&#37; CI&#58; 1&#46;237-7&#46;614&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;016&#41;&#44; 1&#47;640 OR 12&#46;570 &#40;95&#37; CI&#58; 3&#46;659-43&#46;187&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;000&#41; and &#8805;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#44;280 OR 42&#46;136 &#40;95&#37; CI&#58; 8&#46;604-206&#46;345&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;000&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">These results show association titles dilution &#8805;<span class="elsevierStyleHsp" style=""></span>1&#47;320 in ANA&#39;s first test requested by a Rheumatology Unit with patients with systemic connective tissue disease&#46; The VPP in these patients was higher than previous studies requested by other medical specialties&#46; This may indicate the importance of application of the test in a targeted way&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0025"
            "titulo" => "Objective"
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            "identificador" => "abst0030"
            "titulo" => "Method"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Result"
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            "identificador" => "abst0040"
            "titulo" => "Conclusion"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anticuerpo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sensibilidad &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-RNP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-Sm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-SSA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-Ro52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-La&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-Scl70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-Jo1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-centrom&#233;rico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-ribosomal P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-dsDNA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&#44;2&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Sensibilidad y especificidad de los principales anticuerpos determinados mediante inmunoblot con el kit Euroline ANA de Euroimmun</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; IFI&#58; inmunofluorescencia indirecta&#59; VPP&#58; valor predictivo positivo&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No conectivopat&#237;as sist&#233;micas</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Conectivopat&#237;as sist&#233;micas</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Pacientes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">188&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#44;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Edad media&#44; a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#44;9 &#40;DE<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;455&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#44;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&#44;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Sexo</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mujeres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">146&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&#44;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hombres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#44;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Patr&#243;n IFI</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Homog&#233;neo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Moteado fino</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Citoplasm&#225;tico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;424&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nucleolar</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;572&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Centrom&#233;rico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Nuclear dots</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;465&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Membrana nuclear</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mixto</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;675&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ciclo celular</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;454&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Anticuerpos</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-Ro52</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-Ro60</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-La</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-Dna</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-Sm B</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-Sm D</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-RNP 70</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-RNPA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-RNPC</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-ribosomal P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;456&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-centrom&#233;rico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-histonas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;259&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-AMA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;098&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anti-Mi-2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas demogr&#225;ficas e inmunol&#243;gicas de los pacientes incluidos en el estudio</p>"
        ]
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      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabla "
            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">AR&#58; artritis reumatoide&#59; IFI&#58; inmunofluorescencia indirecta&#59; LES&#58; lupus eritematoso sist&#233;mico&#59; VPP&#58; valor predictivo positivo&#46;</p>"
          "tablatextoimagen" => array:2 [
            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Conectivopat&#237;as sist&#233;micas</th><th class="td" title="table-head  " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No conectivopat&#237;as sist&#233;micas</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Diluci&#243;n por IFI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#62;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#60;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total conectivopat&#237;as</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#62;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#60;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total no conectivopat&#237;as</th><th class="td" title="table-head  " align="left" valign="top" scope="col">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#47;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#47;160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#47;320&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#47;640&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#8805;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#46;280&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LES</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">S&#237;ndrome Sj&#246;gren</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Esclerosis sist&#233;mica</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Conectivopat&#237;a indiferenciada</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">AR</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Fibromialgia</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Artrosis</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VVP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPP &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#47;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#47;160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#47;320&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#47;640&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR crudo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">T&#237;tulo ANA &#40;ref&#46; 1&#47;80&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>T&#237;tulo ANA 1&#47;160&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>T&#237;tulo ANA 1&#47;320&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;68 &#40;2&#44;09-10&#44;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;069 &#40;1&#44;237-7&#44;614&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>T&#237;tulo ANA 1&#47;640&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;570 &#40;3&#44;659-43&#44;187&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>T&#237;tulo ANA &#8805;<span class="elsevierStyleHsp" style=""></span>1&#47;1&#46;280&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&#44;97 &#40;8&#44;26-131&#44;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#44;136 &#40;8&#44;604-206&#44;345&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Patr&#243;n moteado fino</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;856&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Patr&#243;n nucleolar</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;779 &#40;0&#44;327-1&#44;858&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Patr&#243;n centrom&#233;rico</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;657 &#40;0&#44;141-3&#44;068&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;594&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Anti-Ro52</span>&nbsp;\t\t\t\t\t\t\n
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