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1.
目的探讨抗环瓜氨酸肽抗体(抗CCP抗体)、类风湿因子(RF)、抗核周因子(APF)、抗角蛋白抗体(AKA)对幼年类风湿关节炎(JRA)诊断的意义,并与类风湿关节炎(RA)进行比较。方法分别采用酶联免疫吸附试验(ELISA)、胶乳凝集法、间接免疫荧光法检测54例JRA患者、31例非RA对照组、116例成人RA患者血清中的抗CCP抗体、RF、APF、AKA。结果54例JRA患者抗CCP抗体、RF、APF、AKA的敏感性分别为61.1%、57.4%、37.0%、18.5%,特异性分别为96.8%、93.6%、96.8%、100%。抗CCP抗体与RF在JRA的敏感性差异无统计学意义,但明显高于APF、AKA;4种抗体在JRA的特异性比较差异无统计学意义。RA患者中4种抗体敏感性分别为82.3%、78.3%、48.7%、25.4%,特异性分别为95.7%、7.3.7%、91.6%、94.0%。4种抗体在JRA诊断中的敏感性均明显低于RA组,RF在JRA患者中特异性明显高于RA患者,而其他3种抗体的特异性在两组患者比较差异无统计学意义。结论虽然抗CCP抗体谱在JRA诊断中的敏感性不及RA组,但对JRA的诊断仍具有较好的敏感性和特异性,可用于JRA的诊断。  相似文献   

2.
目的探讨4种抗瓜氨酸化蛋白,肽抗体(anti-citrufllinated protein/peptide autoantibodies,ACPAs)-抗核周因子(anti-perinuclear fator,APF)、抗角蛋白抗体(anti-keratin antibody,AKA)、抗角蛋白微丝聚集蛋白抗体(antiprofillagrin/fillagrin antibody,AFA)、第二代抗环瓜氨酸肽抗体(second generation of anti-cylic citrulline peptide antibody,CCPⅡ)对类风湿关节炎(rheumatoid arthritis,RA)的诊断意义及其结果的一致性。方法 对129例RA、153例其他风湿性疾病患者和94名健康对照者的血清进行类风湿因子(rheumatoid factor,RF)和ACPAs检测。RF采用乳胶间接凝集法检测。APF和AKA采用间接免疫荧光法检测,AFA、抗CCP(Ⅱ)抗体采用酶联免疫吸附法检测。结果APF、AKA、AFA和抗CCP(Ⅱ)抗体对RA的诊断特异性分别为90.3%、94.7%、93.5%和94.7%,敏感性分别为58.1%、40.3%、62.0%和67.4%;而RF的诊断特异性和敏感性为77.7%和46.5%。APF与AFA、APF与抗CCP(Ⅱ)和AFA与抗CCP(Ⅱ)抗体间检测结果一致性较好,Kappa值分别是0.596、0.572和0.576。结论ACPAs是RA的诊断特异性抗体,其中抗CCP(Ⅱ)抗体的敏感性和特异性最高,且与APF和AFA抗体间结果具有明显的一致性。  相似文献   

3.
目的 评价抗突变型瓜氨酸化波形蛋白(MCV)抗体在类风湿关节炎(RA)诊断中的价值。方法 检测136例RA患者,80例其他结缔组织病患者以及19名正常对照血清中抗MCV抗体的分布,比较抗MCV抗体与类风湿因子(RF)、抗环瓜氨酸肽(CCP)抗体和抗角蛋白抗体(AKA)的相关性,并分析上述抗体在RA诊断中的意义。结果 136例RA患者抗MCV抗体敏感性和特异性分别为95.6%和80.8%.与非RA对照组比较差异有统计学意义(P〈0.05)。抗MCV抗体与抗CCP抗体、AKA和RF的重叠阳性率分别为91.9%、52.8%和76.5%。经统计学分析,抗MCV抗体与抗CCP抗体、AKA和RF之间存在相关性。结论 抗MCV抗体对RA有较高的诊断价值,可视为RA新的血清学诊断指标.能提高RA的早期诊断率。  相似文献   

4.
自身精氨酸肽的瓜氨酸化与类风湿关节炎   总被引:1,自引:1,他引:0  
类风湿关节炎(rheumatoid arthritis,RA)患者血液中存在许多针对大量自身抗原的自身抗体,其中被广泛了解的是类风湿因子(RF),但RA中RF阳性率仅约75%,而且RF也可出现在其他风湿性疾病和感染性疾病中.甚至一部分正常人中,对RA的诊断价值受到限制。四十余年研究发现抗核周因子(APF)、抗角蛋白抗体(AKA)、抗丝聚蛋白抗体(anti-fi-laggrin antibody,AFA)、抗Sa抗体、抗环瓜氨酸肽(cyclic citrullinated peptide,CCP)抗体是RA的特异性抗体,这些抗体几乎不出现在其他风湿性疾病、炎症疾病以及正常人中.特别是抗CCP抗体对RA诊断的敏感性达80%,特异性达90%~100%。这些抗体所针对的抗原肽均包含非标准氨基酸一瓜氨酸,瓜氨酸肽是由肽酰基精氨酸脱亚氨酶(PADI)对包含精氨酸的肽脱亚氨基而来.因此这些抗体统称抗瓜氨酸肽抗体(ACPA)。  相似文献   

5.
抗核周因子和抗角蛋白抗体的临床应用研究   总被引:4,自引:2,他引:2  
目的 通过大样本研究:①进一步了解证实抗核周因子(APF)、抗角蛋白抗体(AKA)在类风湿关节炎(RA)患者中的敏感性、特异性和联合检测的意义,探讨早期诊断价值,为临床推广应用提供依据。②了解APF、AKA在非RA风湿性疾病中的分布情况,探讨APF、AKA在非RA风湿性疾病中阳性观察的意义,这些患者是否有关节损害等。方法 选取1999年4月至2003年4月山西医科大学第二医院风湿科门诊及住院患者1903例,RA组753例,其他风湿性疾病1150例。APF以人颊黏膜细胞为抗原底物,AKA以Wistar大鼠食管中段切片为抗原底物,皆用间接免疫荧光法进行检测。结果 ①在血清1:20稀释时APF对诊断RA的敏感性39.46%、特异性96.41%(全部患者)、94.72%(剔除SpA)。②以点片状加板层状为阳性判断标准,AKA对诊断RA的敏感性25.44%、特异性95.96%(全部患者)、93.82%(剔除SpA)。③与小样本比较敏感性下降,特异性提高,APF、AKA特异性明显高于类风湿因子(RF)。④APF、AKA、RF3种抗体联合检测时,1种以上任何抗体出现对RA诊断敏感性69.83%,2种以上抗体同时出现特异性98.19%,3种抗体同时出现特异性99.86%接近100%。⑤APF、AKA可出现于其他结缔组织疾病,这两种自身抗体在脊柱关节病、骨关节炎中很少出现。⑥其他风湿性疾病(不包括重叠综合征),AKA与腕关节、掌指关节(MCP)、近端指间关节(PIP)受累相关,AKA、APF与各关节受累未发现相关。结论 临床常规大样本检测证实:①APF、AKA对RA高度特异。②APF、AKA、RF联合检测,可互为补充,可提高诊断RA的特异性,自身抗体阳性种类越多,特异性越强,对RA诊断价值更高。③非RA风湿性疾病,AKA与腕关节、MCP、PIP受累相关。  相似文献   

6.
目的:探讨抗聚角蛋白微丝蛋白抗体(AFA)对RA诊断的意义,并比较其与抗核周因子抗体(APF),抗角蛋白抗体(AKA)以及HLA-DR4之间的相关性。方法;用免疫印迹法(WB)检测157例类风湿关节炎(RA)血清标本和104例对照血清,包括系统性红斑 狼疮(SLE)、干燥综合征(SS)、骨关节炎(OA)等的AFA。APF和AKA用间接免疫荧光法检测。结果:157例RA病人的AFA敏感性和特异性分别为36.3%、 93.4%,与疾病对照组和正常对照组相比,差异有显著性(P<0.05)。57例AFA阳性的血清中,其中AKA同时阳性的有36例,重叠为63.2%;APF同时阳性的有38例,重叠率为66.7%;HLA-DR4同时阳性的有36例,重叠率为52.6%。统计学分析证实AFA与AKA、APF及HLA-DR4之间有相关性。结论:AFA对RA具有很高的特异性,可用于RA的临床诊断。AFA与APF、AKA及GLA-DR4有相关性。AFA不能完全替代APF和AKA,三项临床检测可互相补充,提高RA的诊断率。  相似文献   

7.
目的比较第1代与第2代抗环瓜氨酸肽(anti-cyclic citrutlinated pepfide,CCP1,CCP2)抗体对类风湿关节炎(rheumatoid arthritis,RA)的诊断价值。方法对129份RA、153份其他风湿性疾病和94份健康对照血清进行检测。类风湿因子(rheumatoid factor,RF)检测采用乳胶间接凝集法,抗CCP1和抗CCP2抗体检测采用酶联免疫吸附法。结果对RA的诊断敏感性,抗CCP2抗体高于RF和抗CCP1抗体,分别为67.4%、46.5%和46.5%,差异有显著性意义(P=0.001);抗CCP1和抗CCP2抗体对RA的诊断特异性均为94.7%,而RF的诊断特异性仅为77.7%,差异亦有显著性意义(P〈0.001)。结论抗CCP2抗体对RA诊断有较好的敏感性和较高的特异性。  相似文献   

8.
抗突变型瓜氨酸波形蛋白抗体在类风湿关节炎诊断中的意义   总被引:11,自引:1,他引:10  
目的了解抗突变型瓜氨酸波形蛋白(MCV)抗体在类风湿关节炎(RA)诊断中的意义,并比较抗MCV抗体与类风湿因子(RF)、抗核周因子(APF)、抗角蛋白抗体(AKA)、抗环瓜氨酸多肽(CCP)抗体以及某些临床指标的相关性。方法对166例研究对象,包括74例RA患者(其中早期18例,中晚期56例),50例非RA的风湿性疾病患者,42名健康对照,应用酶联免疫吸附试验(ELISA)检测血清中的抗MCV抗体,同时检测其他相关自身抗体,结合临床资料进行分析。结果74例RA中抗MCV抗体阳性58例,对RA诊断的敏感性为78%,特异性为95%,阳性预测值和阴性预测值分别为97%和71%。抗MCV抗体阳性的平均抗体浓度依次为(552±380)U/ml(RA组),(162±63)U/ml(非RA组),(63±46)U/ml (健康对照组)。RA组的平均抗体水平较高。抗MCV抗体和抗CCP抗体相关性最强(r=0.502,P=0.000),APF、AKA次之(r=0.369、0.408,P<0.01)。抗MCV抗体与各项临床、实验室指标间的差异无统计学意义(P>0.05)。结论抗MCV抗体在RA中具有较高的敏感性和特异性,且较APE、AKA与抗CCP抗体相关性强,可作为RA诊断的辅助指标。抗MCV抗体可能与病情活动度、功能状态无关。  相似文献   

9.
目的:探讨抗环瓜氨酸(CCP)抗体、抗角蛋白(AKA)抗体、抗核周因子(APF)和RA33抗体在老年起病类风湿关节炎(EORA)诊断和鉴别诊断中的临床意义。方法:对95例EORA(EORA组)、69例风湿性多肌痛(PMR)患者(PMR组)和47例健康者(对照组)进行抗CCP抗体、AKA、APF和RA33抗体检测,其中抗CCP抗体和RA33抗体采用酶联免疫吸附法(ELISA法)检测,AKA和APF采用间接免疫荧光法(ⅡF)法检测。结果:①抗CCP抗体、AKA、APF和RA33抗体在EORA组的敏感性和特异性分别为(58.9%、95.8%)、(33.7%、91.4%)、(31.6%、89.4%)和(36.8%、86.7%),显著高于PMR组和对照组(P〈0.01)。②EORA组抗CCP抗体的敏感性显著高于AKA、APF和RA33抗体(P〈0.05)。联合检测4种抗体,敏感性有所降低,但使阳性率提高至98.9%,且有更高的阳性预测值。③69例PMR患者中有6例患者CCP抗体阳性,3例AKA阳性,且与CCP抗体相重叠,2例APF阳性,2例RA33阳性,1年后3例重叠阳性的PMR患者确诊为EORA。结论:PMR与EORA有相似的临床症状和特征,临床上有时难以鉴别,极少数病例,在早期不典型时易误诊,但抗CCP抗体、AKA、APF和RA33抗体仍主要出现在EORA患者中,尤其抗CCP抗体有较高的敏感性和特异性,4种抗体联合检测有更高的特异性和阳性预测值,同时结合临床症状、影像学改变等,4种抗体联合检测对EORA的诊断和鉴别诊断有很高的临床应用价值。  相似文献   

10.
目的研究类风湿因子(RF)、抗环瓜氨酸(CCP)抗体、抗角蛋白抗体(AKA)、抗核周因子抗体(APF)对老年类风湿关节炎(RA)的诊断价值。方法 RA患者480例为RA组,非RA自身免疫病患者300例为非RA组,健康组300例,对受检者进行RF、抗CCP抗体、AKA、APF检测。结果 RA组分别与非RA组和健康组比较,4种检测标志物阳性检出率均有显著性差异(P0.05)。单项指标比较,RF有较高的灵敏度,但特异性明显低于其他3个指标(P0.05),AKA、APF虽有较高的特异度,但灵敏度低(P0.05),抗CCP抗体有较高的灵敏度和特异度。对RA组各指标联合检测,以上指标任意2个组合比3项(抗CCP抗体+RF+APF,抗CCP抗体+RF+AKA)、4项(抗CCP抗体+RF+APF+AKA)联合检测敏感度低(P0.05),而特异度均较高,但没有明显差异(P0.05)。4项联合检测灵敏度及特异度达到最高。结论单项指标比较,抗CCP抗体有较高的灵敏度和特异度。联合指标比较,以抗CCP抗体+RF+APF或抗CCP抗体+RF+AKA3项联合检测模式诊断RA具有较高的价值,便于临床医师早期确诊,减少漏诊误诊病例。  相似文献   

11.
OBJECTIVE: To explore the diagnostic value of anti-cyclic citrullinated peptide antibody (anti-CCP) detected by ELISA in patients with rheumatoid arthritis (RA). METHODS: The synthesized cyclic citrullinated peptide was used as substrate for ELISA. Anti-CCP antibody was detected by ELISA in 191 patients with RA, 132 with rheumatic diseases other than RA, and 98 with nonrheumatic diseases. The antiperinuclear factor (APF), anti-keratin antibody (AKA), rheumatoid factor (RF), and HLA-DR4 gene complex were also tested in each RA patient. The results of these tests were compared with anti-CCP antibody to examine the correlation between them. RESULTS: Ninety (47.1%) patients with RA, 4 (3.0%) with other rheumatic diseases, and 2 (2.0%) with nonrheumatic diseases were found to be anti-CCP antibody positive by ELISA. The sensitivity of anti-CCP antibody was 47.1%, with a high specificity (97.4%) in RA. Anti-CCP antibody correlated with APF, AKA, RF, and HLA-DR4 gene complex. CONCLUSION: A new modified anti-CCP antibody test had a moderate sensitivity (47.1%) but a high specificity (97.4%) in patients with RA and was found as a valuable supplement to diagnosis of RA. Anti-CCP correlated with APF, AKA, RF, and HLA-DR4 gene complex, but did not completely overlap with them. Anti-CCP antibody could be regarded as a new diagnostic marker for RA.  相似文献   

12.
Aim: To determine the frequency of anti‐cyclic citrullinated peptide antibody (anti‐CCP) in a group of patients with rheumatoid arthritis and another group with other rheumatic diseases. Patients and methods: Anti‐CCP1 and rheumatoid factor (RF) titres were determined in 320 serum samples; 136 from RA patients, 184 from control patients (165 patients with rheumatic diseases other than RA, and 21 patients with lymphoproliferative diseases). Results: The sensitivity of Anti‐CCP was 62.5% (95% CI: 53–70%) for the diagnosis of RA with a specificity of 89.1% (95% CI: 83–93%). The sensitivity of RF was 85.3% (95% CI: 79–91%). The specificity was 64.7% (95% CI: 57–71%). Conclusions: Anti‐CCP1 has not very high specificity for RA regarding other rheumatic disease. However it is still very helpful for the diagnosis of RA.  相似文献   

13.
Aim: The objectives of this study are to provide data regarding the prevalence of anti‐cyclic citrullinated peptide (CCP) antibodies in Malaysian rheumatoid arthritis (RA) patients and to correlate the levels of anti‐CCP antibody with the Disease Activity Score (DAS). Method: We studied the prevalence of anti‐CCP antibodies in 51 RA patients attending our clinic and 29 controls. We also looked for correlation between anti‐CCP antibody levels with the DAS and parameters such as duration of disease, rheumatoid factor (RF) and disease‐modifying anti rheumatic drug (DMARD) usage. Results: None of the controls demonstrated anti‐CCP antibodies. Forty‐one out of 51 patients (80.4%) were positive for anti‐CCP antibodies. Sensitivity and specificity were 80.4% and 100% respectively in this study. Anti‐CCP levels correlated significantly with rheumatoid factor, but no correlation was observed with the other parameters. Conclusions: Anti‐CCP antibody is prevalent in Malaysian RA patients at 80.4% and more sensitive than RF in our cohort of established RA patients. Even though the anti‐CCP levels correlated with RF, it did not show correlation with DAS.  相似文献   

14.
四种抗体联合检测在类风湿关节炎早期诊断中的应用价值   总被引:3,自引:2,他引:1  
目的 探讨抗核周因子抗体(APF)、抗角蛋白抗体(AKA)、类风湿因子(RF)、抗环瓜氨酸肽抗体(抗-CCP抗体)联合检测在类风湿关节炎(RA)早期诊断中的临床应用价值。方法 对RA患者127例、非RA其他风湿病患者102例及正常对照组43例,采用速率散射免疫比浊法检测RF;酶联免疫吸附法定量检测抗-CCP抗体;免疫荧光法检测AKA、APF,并采用四格表法计算敏感度及特异性。结果RA组的RF、APF、AKA、抗-CCP抗体敏感度分别为65.4%、48.8%、32.3%、83.5%,特异性分别为73.5%、92.2%、93.1%、94.1%,同时出现三种抗体和四种抗体的特异性为99.0%、100%;非RA组无四种抗体同时出现的情况。结论 RF敏感性较高,但特异性较差;APF、AKA、抗-CCP抗体三种自身抗体对RA具有高度特异性,且在RA早期即可出现。四种抗体联合检测有助于提高RA的早期诊断率。  相似文献   

15.
We compared the diagnostic performance of anti-cyclic citrullinated peptide antibodies detected with second-generation enzyme immunoassay (anti-CCP2) with that of IgM-rheumatoid factor (RF), anti-perinuclear factor (APF), and anti-keratin antibodies (AKA). The sensitivity of anti-CCP2 was better than that of APF and AKA: they were detected in 25% rheumatoid arthritis (RA) patients without detectable APF or AKA. Their specificity, evaluated in other inflammatory rheumatic disease, was similar to that of APF and AKA. Despite the lower specificity, IgM-RF in combination with anti-CCP2 is interesting, as they do not completely overlap. Anti-CCP2 antibody detection seems to be a good alternative to other anti-filaggrin antibodies in the diagnosis of RA.  相似文献   

16.
OBJECTIVES: To assess the clinical value of several serological markers in Lithuanian patients with rheumatoid arthritis (RA) compared with control patients with rheumatic disease and age matched healthy controls. METHODS: Serum samples from 96 patients with RA of approximately 8 years' duration, 90 rheumatic disease controls, and 37 healthy subjects were tested. Antikeratin antibody (AKA), antineutrophil cytoplasmic antibody (ANCA), and antinuclear antibody (ANA) titres were estimated by indirect immunofluorescence (IIF) and serum samples positive for ANA and ANCA were further studied by enzyme linked immunosorbent assay (ELISA). IgA and IgM rheumatoid factors (RF) were measured by ELISA. RESULTS: A positive AKA test was highly specific for RA (diagnostic specificity 97%), being found in 44% of the patients. Although both RF tests had a higher sensitivity, they were less specific for RA. ANCA was detected in 33% of patients with RA but lacked diagnostic specificity. AKA and ANCA were associated with more erosive disease and the presence of extra-articular manifestations. Positivity for AKA, IgA RF, and ANCA was significantly associated with disease activity and worse functional capacity. However, in multiple regression analysis only positivity for AKA was significantly correlated with functional disability (p=0.0001), evaluated by the Steinbrocker functional classification, and no single marker had any relation with radiological damage. CONCLUSION: Although AKA showed the highest disease specificity, all serological markers studied except ANA exhibited interesting associations with important clinical and paraclinical parameters of RA.  相似文献   

17.
老年类风湿关节炎患者抗角蛋白抗体检测意义   总被引:7,自引:0,他引:7  
目的:了解抗角蛋白抗体(AKA)对老年类风湿关节炎(EORA)的诊断意义。方法:以Wistar大鼠中1/3食管组织冰冻切片为底物,采用间接免疫荧光光检测51例EORA及139例对照组的血清AKA,记录同期临床及实验室指标。结果:AKA对EORA诊断敏感性为31.4%,特异性为98.6%,早期EORA患者AKA阳性率28.6%,AKA阳性组IgM、血沉(ESR)较阴性组高;医生及患者对病情活动性评分、Sharp评分有增高趋势。16例AKA阳性EORA中,类风湿因子(RF)、抗核周因子(APF)、抗Sa抗体阳性数分别为11、15例和4例,AKA和APF相关。结论:AKA有助于EORA诊断及早期诊断,是病情活动性及严重性指标。  相似文献   

18.
Background: The anti‐cyclic citrullinated peptide (anti‐CCP) antibody test is a new serological marker with high specificity for rheumatoid arthritis (RA). Aims: This study evaluated the frequency of anti‐CCP antibodies in comparison to rheumatoid factor (RF) in a group of patients with inflammatory polyarthritis. Methods: Samples were obtained from 106 patients with established RA and non‐RA inflammatory polyarthritis. Anti‐CCP (second generation assay – INOVA) and RF antibodies were measured by enzyme‐linked immunosorbent assay. Patient demographics, disease duration and clinical diagnosis were obtained. Results: Fifty‐five patients had established RA and the remaining 51 had non‐RA inflammatory polyarthritis. The sensitivity of the anti‐CCP2 assay for a diagnosis of RA was 73% compared with 56% for RF. In the RA group, half the RF negative patients (12/24) tested positive for anti‐CCP. The specificity of anti‐CCP was extremely high at 98% compared with RF at 94%. In the non‐RA group, only one patient with lupus tested positive for anti‐CCP compared with three who were RF positive (all of whom also had lupus). Conclusion: The second generation anti‐CCP assay was more sensitive and specific than RF for a diagnosis of RA in this population. This test may improve accuracy of diagnosis in patients with long‐standing polyarthritis.  相似文献   

19.
OBJECTIVE: To compare the diagnostic values of antiperinuclear factor (APF), antikeratin antibody (AKA), and anti-cyclic citrullinated peptides (anti-CCP) to discriminate between patients with and without rheumatoid arthritis (RA) and to determine the diagnostic value of anti-CCP used alone or with other tests. METHODS: Two hundred and seventy patients with early arthritis underwent standardized investigations in 1995-1997. The clinical utility of APF, AKA, and anti-CCP in first-visit sera was evaluated using receiver-operating characteristic curves. Combinations of anti-CCP with other laboratory tests were assessed by multiple logistic regression. RESULTS: Anti-CCP, APF, and AKA were not perfectly correlated with one another. Anti-CCP with 53 UI as the cutoff was 47% sensitive and 93% specific, versus 52% and 79%, and 47% and 94%, for APF and AKA, respectively. Multiple logistic regression selected anti-CCP, AKA, IgM-rheumatoid factor (RF) ELISA, and the latex test. CONCLUSION: Rheumatologists can routinely use 2 or 3 tests for diagnosing RA (latex and/or IgM RF ELISA, and either AKA or anti-CCP ELISA) and can add a third or fourth test when the diagnosis remains in doubt.  相似文献   

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