间接免疫荧光法和免疫印迹法联合检测抗聚角蛋白微丝蛋白抗体对类风湿关节炎的诊断价值

目的探讨用间接免疫荧光(IIF)和免疫印迹(IB)两种方法联合检测抗聚角蛋白微丝蛋白抗体(AKA/AFA)对类风湿关节炎(RA)诊断的价值。方法对401份血清标本进行检测,包括185例RA,164例非RA的风湿病患者,52名健康对照。以Wistar大鼠食管中段角质层冰冻切片为底物,用IIF法检测抗角蛋白抗体(AKA/AFA),以人乳腺癌上皮提取的聚角蛋白微丝蛋白为抗原,用IB法检测AFA。结果IIF法、IB法及两种方法联合检测AFA的敏感性分别为36.7%、46.5%、56.2%,特异性分别为94.5%、95.7%、93.3%,两种方法联合检测阳性预测值90.4%,阴性预测值65.4%。联合检测较IIF法单独检测敏感性增加20%,经χ2检验差异有显著性(P<0.01);联合检测较IB法单独检测敏感性增加10%,经χ2检验差异无显著性(P=0.058);而联合检测没有降低其特异性(P>0.05;P>0.05)。在164例非RA病人对照组中,两种方法联合检测AFA阳性11例,1年追踪观察结果显示,其中3例符合1987年ACR的RA的诊断标准4条以上,另外3例符合3条。结论AFA是RA的特异性血清学标记,IIF法和IB法检测AFA有相似的诊断价值,特异性高而敏感性低;两种方法检测结果相关,但不重叠;联合使用两种方法检测AFA有助于提高RA诊断的敏感性。

The value of using dual indirect immunofluorescence and immunoblotting assays for antifilaggrin autoantibodies in the diagnosis of rheumatoid arthritis

Objective To determine the significance of measuring antifilaggrin autoantibody using dual indirect immunofluorescence(IIF)assays and immunoblotting(IB)assays and the combination of IIF and IB in the diagnosis of rheumatoid arthritis(RA).Methods Sera from401patients were studied:185from patients with RA,164from patients with non-RA rheumatic diseases,52from healthy blood donors.AKA/AFA were detected by IIF,AFA were detected by IB.Results The sensitivity and specificity of AFA using IIF,IB and both techniques for RA were36.7%&94.5%,46.5%&95.7%,56.2%&93.3%,respectively.When both IIF and IB techniques were used,sensitivity for RA increased to61.6%compared with IIF(P<0.01)and IB alone(P=0.058)with no decrease in specificity(P>0.05;P>0.05,respectively).Eleven positive sera for both IIF and IB were found in164control patients were found.Followed the patients for up1year showed that3cases met more than4of7of the ACR criteria,other3cases met3of7of the ACR criteria.Conclusion AFA is a spe-cific serological marker.The detection of AFA using IIF and IB technique has a similar diagnostic value,the specificity is high and sensitivity is low.However,because the two tests do not completely overlaps,combining IIF with IB technique can improve diagnostic sensitivity.Performing these2different techniques performed si-multaneously for detecting AFA is useful in clinical practice.