类风湿因子和抗环瓜氨酸多肽抗体联合检测在类风湿关节炎诊断中的意义

目的:评估抗聚丝蛋白抗体群(AFAs)抗体与类风湿因子(RF)联合检测在类风湿关节炎(RA)诊断中的意义. 方法:分别检测266例RA患者和186例对照者血清中的RF和抗角蛋白抗体(AKA)、抗核周因子(APF)、抗环瓜氨酸多肽(CCP)抗体等AFAs.以乳凝法检测RF-IgM,酶联免疫吸附法检测RF-IgG、IgA及抗CCP抗体,间接免疫荧光染色法检测AKA、APF,并分析上述抗体在RA诊断中的意义. 结果:与单独检测RF相比,联合检测RF和抗CCP抗体可使敏感度由65.8%提高至86.5%,二者特异度相当,分别为80.6%和81.8%.在RF阴性的91例RA患者中,64.8%的患者至少1项AFAs阳性,其中抗CCP阳性者占59.3%.AKA和APF特异性很高,但敏感性低. 结论:AFAs与RF联合检测可显著提高RA的诊断率,尤其在RF阴性的RA患者中更具有意义.但以目前的检测方法,AKA和APF的敏感性太低.临床上,以RF和抗CCP抗体联合测定更为实用.

Diagnostic significance of combined detection of rheumatoid factor and anticyclic citrullinated peptide antibodies in rheumatoid arthritis

Objective:To evaluate the significance of the combination of rheumatoid factor (RF) and anti-filaggrin antibodies (AFAs) in the diagnosis of rheumatoid arthritis (RA). Methods:Sera from 266 RA patients and 186 controls were studied. RF and some kinds of AFAs (including antikeratin antibodies, anti-perinuclear factor and anticyclic citrullinated peptide antibodies) were detected using immunofluorescence and ELISA respectively. The distributions of these antibodies were compared to determine the significance of the combination of RF and AFAs. Results:The sensitivity and secificity of RF for the diagnosis of RA were 65.8% and 81.8% respectively, as compared with those of anti-CCP or RF positive were 86.5% and 80.6% respectively. Only a slight change was found in the secificity and negative predictive value between them. RF could not be detected in 91 patients while 64.8% of them could be found to have at least one kind of AFAs. Conclusion:AFAs, particular anticyclic citrullinated peptide antibodies, could be helpful for the diagnosis of RA especially in RF-negative patients.