类风湿关节炎中抗纤聚蛋白抗体意义的探讨

目的探讨抗纤聚蛋白抗体(AFA)在类风湿关节炎(RA)中的意义,并比较AFA与类风湿因子(RF)、抗角蛋白抗体(AKA)、抗核周因子(APF)和抗环瓜氨酸肽(CCP)抗体以及某些临床指标的相关性。方法对860例研究对象,包括388例RA患者(其中早期172例,中晚期216例),422例非RA的风湿性疾病患者,50名健康对照,用免疫印迹法(IB)检测血清中的AFA。同时检测其他RA相关自身抗体。结果AFA在早期RA病例中阳性率为62.2%,在中晚期RA病例中阳性率为58.8%,对RA诊断敏感性60.3%,特异性91.1%,阳性和阴性预测值分别为94.6%、68.0%。AFA和AKA在早期和中晚期RA的阳性率差异无统计学意义,而RF、APF和抗CCP抗体在中晚期组的阳性率大于早期组。AFA与RF、AKA、APF以及抗CCP抗体相关(P<0.05)。AFA与RA患者平均发病年龄相关(P=0.047)。结论AFA可视为RA的特异性血清学标记,尤其对RF阴性及早期RA诊断很有帮助;AFA与其他RA相关自身抗体相关,联合检测可以相互补充,提高对RA的诊断。

Antifilaggrin antibody in patients with rheumatoid arthritis

Objective To determine the significance of antifilaggrin antibodies (AFA) in patients with rheumatoid arthritis (RA) and study the correlation among AFA, other autoantibodies and clinical manifestations of RA. Methods AFA were detected by immunoblotting (IB) in 860 serum samples including 388 from RA (172 cases with early RA and 216 cases with late RA), 422 from non-RA rheumatic diseases and 50 cases of healthy blood donors. At the same time, other autoantibodies were detected by different techniques. Results AFA were present in 62.2% (107/172) of the early RA and 58.8% (127/216) of the late RA. The sensitivity and specificity of AFA in RA were 60.3% and 91.1%. The positive and negative predictive value was 94.6% and 68.0%. There was no difference in the sensitivity of AFA and AKA between the early RA and late RA while the positive rates of RF, APF and anti-CCP antibody in late RA were higher than those in early RA. AFA was correlated to RF, AKA, APF and anti-CCP antibody (P<0.05). The average onset age of AFA-positive patients was older than that of AFA-negative ones. Conclusion AFA may be a specific serological marker. It is highly valuable to diagnose seronegative and early RA. AFA is correlated to other autoantibodies related to RA. AFA may be an alternative or complementary to conventional serological markers such as RF, APF, anti-CCP and AKA. When they are tested together, the sensitivity may be increased evidently.