自身抗体阳性的未分化关节炎向类风湿关节炎转化的预测价值

目的 探讨类风湿因子(RF)、抗角蛋白抗体(AKA)、抗环瓜氨酸肽(CCP)抗体、抗核周因子(APF)4种自身抗体对未分化关节炎(UA)转化为类风湿关节炎(RA)的临床预测价值,并分析其临床相关因素.方法 对271例UA患者随访1年,采用免疫比浊法检测RF,酶联免疫吸附试验(ELISA)检测抗CCP抗体,间接免疫荧光法(IIF)检测APF与AKA,魏氏法测定红细胞沉降率(ESR),记录患者的晨僵时间、关节肿胀数、关节压痛数、不同关节受累及DAS28评分.结果 4种抗体均阳性的UA患者转化为RA的阳性率为99%;任2种及2种以上抗体阳件的UA患者转化为RA的敏感性83.0%,特异性65.9%;RF/抗CCP抗体阳性的UA患者转化为RA的敏感性77.8%,特异性80.5%;抗体均阴性和任1、2、3种抗体阳性及4种抗体全阳性患者的多关节肿胀及多个小关节受累的比率分别为48%、57%、59%、70%、70%和71%、71%、72%、76%、82%;抗体阴性的UA患者中肘关节受累所占比例最大,为72%;多关节肿胀及多个小关节受累在UA转化为RA与无多关节肿胀及多个小关节受累的转化率最大.结论 4种抗体联合检测可提高RA早期诊断的特异性,阳性抗体越多.UA越容易发展为RA;RF/抗CCP抗体阳性的UA患者转化为RA的敏感性和特异性均较高.多关节肿胀和多个小关节受累对评估RA病情有重大意义.

The clinical predictive value analysis of multi-autoantibodies detection in the transformation from undifferentiated arthritis to rheumatoid arthritis

Objective To investigate the clinical predictive value of rheumatoid factor (RF), anti-keratin antibodies (AKA), anti-cyclic citrullinated peptide (anti-CCP) antibody and anti-perinuclear factor (APF) in the transition from undifferentiated arthritis (UA) to rheumatoid arthritis (RA), and to analyze the clinical relevant factors. Methods 271 patients with UA who were followed up for a year were enrolled into the investigation. RF was measured by the rate scatting immunity method. APF and AKA were detected by immuniofluorescence method(IFA). Anti-CCP was measured by ELISA. Erythrocyte sedimentation rate (ESR) was analyzed by Wilcoxon method. The duration of morning stiffness, the numbers of swelling and tender joints, tender joints involved and DAS28 score were recorded and analyzed. Results 99% patients who had four-antibody-positive finally convetted from UA to RA. The conversation rate for those who had two or more than two antibody-positive was 83.0% and 65.9% respectively. The sensitivity and specificity of RF and anti-CCP antibody-positive in those who converted from UA to RA was 77.8% and 80.5% respectively. The percentage of polyarticular swelling in antibody-negative, one-antibody-positive, two-antibody-positive, three-antibody- positive and four-antibody-positive was 48%, 57%, 59%, 70% and 70% respectively. Meanwhile, the percentage of multi-small-joint involvement was 71%, 71%, 72%, 76% and 83% respectively. The proportion of elbow involvement in antibody-negative patients was 72%, which was the highest among all joint area involvement. The conversion differences of the group with more than 3 swelling joints or more than 3 small joints involvement ranked the first and second in frequency. Conclusion The combined detection of these autoantibodies could increase the specificity of early diagnosis of RA. The more positive antibodies present, the more likely the concersion form UA to RA. The sensitivity and specificity of RF and anti-CCP-positive is high, so the latter is expected to become one of the diagnostic criteria. The polyarticular swelling and multi-small-joint involvement are valuable in predicting the transformation from UA to RA.