联检多项指标对类风湿关节炎诊断的临床价值

目的:探讨类风湿因子(Rheum atoid factor,RF)、抗角质蛋白抗体(AKA)、C-反应蛋白(C-reactiveprote in,CRP)和血沉(erythrocyte sed im entation rate,ESR)联检对类风湿关节炎(rheum atoid arthritis,RA)的临床诊断价值。方法:对35例类风湿关节炎患者、30例系统性红斑狼疮和30名正常健康体检者的RF、AKA、CRP及ESR检测,应用速率散射比浊法测定RF和CRP;间接免疫荧光法检测AKA;应用魏氏法测定ESR值。结果:35例RA患者血清中,RF灵敏度和特异性分别为71.4%、91.7%,AKA灵敏度和特异性分别为34.3%、96.7%,CRP灵敏度和特异性分别为91.4%、25%,ESR灵敏度和特异性分别为88.6%、83.3%。联检RF和AKA的灵敏度和特异性分别为81.2%、99.7%,联检RF、AKA、CRP及ESR的灵敏度和特异性分别为99.98%、99.97%。结论:RF、AKA、CRP及ESR可作为RA诊断的血清学指标,且四者联检有助于提高RA诊断的灵敏度及特异性。

Diagnostic Value of Combined Determination of Blood RF, AKA, CRP Contents and ESR for Rheumatoid Arthritis

Objective To explore the clinical usefulness of combined determination of blood rheumatoid factor(RF),anti-keratin antibody(AKA),CRP contents and ESR for diagnosis of rheumatoid arthritis(RA).Methods Serum contents of RF,CRP(with rates nephelometry) and serum contents of AKA(with indirect immuno-fluorescence method) as well as ESR were determined in 35 patients with RA,30 patients with SLE and 30 controls.Results The diagnostic sensitivity and specificity of RF for RA were 71.4% and 91.7% respectively,those of AKA were 34.3% and 96.7% respectively.With combined determination of RF and AKA,the sensitivity was 81.2% and the specificity was 99.7%.The acute phase reaction product CRP was very sensitive(91.4%) but non-specific(25%).The same was true for ESR(sensitivity 88.6%,specificity 83.3%).With combined determination of these four factors,the sensitivity and specificity were the highest(99.98% and 99.97% respectively).Conclusion RF,AKA,CRP and ESR could be used as the diagnostic serum marker for rheumatoid arthritis and combined determination of these four would produce a near perfect result..