抗环瓜氨酸肽抗体检测在类风湿关节炎中的诊断及预后意义探讨

目的 评价抗环瓜氨酸肽(CCP)抗体和类风湿因子(RF)在鉴别类风湿关节炎(RA)和其他风湿性疾病中的意义．探讨RA骨侵蚀与上述两种抗体之间的相关性。方法采用横断面研究，在125例RA．56例其他风湿性疾病，55例非风湿性疾病中检测上述两种抗体，其中抗CCP抗体采用酶联免疫吸附试验(ELISA)法．IgM-RF采用速率比浊法。分析RA骨侵蚀与上述两种抗体之间的相关性。结果IgM-RF诊断RA的敏感性较抗CCP抗体高(RF58．4％，抗CCP抗体54．4％)(P=0．57)；但抗CCP抗体有更高的诊断特异性(抗CCP抗体94．6％，IgM-RF84．7％)(P=0．015)，且两种检测方法之间无相关性。联合检测抗CCP抗体和IgM-RF有很高的特异性98．2％．较单独检测IgM-RF有更高的阳性预测值(PPV)95．7％(P=0.019)．阴性预测值(NPV)有下降57.7％(P=-0.213)。抗CCP抗体阳性、IgM-RF阳性与RA骨侵蚀相关。结论抗CCP抗体与IgM-RF比较对RA有良好的诊断敏感性与特异性．可视为RA新的血清学诊断指标。抗CCP抗体与RA骨侵蚀的关系值得进一步研究。

The diagnostic and prognostic value of anti-cyclic citrullinated peptide antibody in patients with rheumatoid arthritis

Objective To examine the value of anti-cyclic citrullinated peptide(CCP)antibodies and rheumatoid factor(RF)in differenting patients with rheumatoid arthritis(RA)from other rheumatic diseases,and to determine whether the erosions in RA are associated with anti-CCP positivity.Methods In a cross-sectional study,it was determined that the concentrations of the two markers in125RA patients and111con-trols(including56with other rheumatic diseases and55with non-rheumatic diseases).Erosions were quanti-fied with the Sharp score in125RA patients.Results Sensitivity was higher for RF(58.4%),followed by anti-CCP antibodies(54.4%)(P=0.57).Specificity was higher for anti-CCP antibodies(94.6%),followed by RF(84.7%)(P=0.015).The combination of anti-CCP and RF had a very high specificity(98.2%)and a rather low sensitivity(36%).Using this combination resulted in a significantly higher positive predictive value(PPV)of95.7%(P=0.019)and only a slightly lower negative predictive value(NPV)of57.7%(P=0.213),as compared with the use of RF alone.A correlation with the erosions was observed for RF and anti-CCP pos-itivity.Conclusions With their excellent specificity,anti-CCP antibodies can be useful in establishing the diagnosis of RA.Its correlation with the erosion disease deserves further examinations.