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抗核周因子等四种抗体联合检测在早期类风湿关节炎诊断中的意义
引用本文:李鸿斌,李小峰,甘晓丹.抗核周因子等四种抗体联合检测在早期类风湿关节炎诊断中的意义[J].中华医学杂志,2000,80(1):20-24.
作者姓名:李鸿斌  李小峰  甘晓丹
作者单位:[1]中国医学科学院中国协和医科大学北京协和医院风湿免疫内科 [2]中国医学科学院中国协和医科大学北京协和医院风湿
摘    要:目的 探讨抗核周因子(APF)、抗角蛋白抗体(AKA)、抗Sa抗体及抗RA33抗体较类风湿因子对早期类风湿关节炎(RA)诊断的特异性和敏感性。方法 对128例RA患者,分别以人颊粘膜和大鼠的食道角质层为底物用间接免疫荧光法检测APF和AKA。抗Sa抗体和抗RA33抗体用免疫印迹法检测。Sa抗原由人胎盘提取,RA33抗原来源于Ehrlich细胞。结果 (1)APF、AKA、抗Sa抗体、抗RA33抗体

关 键 词:类风湿性关节炎  诊断  抗核周因子  抗体
修稿时间:1999-02-04

Specific antibodies for the early diagnosis of rheumatoid arthritis
LIHongbin,LIXiaofeng,GANXiaodan,etal.Specific antibodies for the early diagnosis of rheumatoid arthritis[J].National Medical Journal of China,2000,80(1):20-24.
Authors:LIHongbin  LIXiaofeng  GANXiaodan  etal
Institution:Department of Rheumatology and Immunology, Peking Union Medical College Beijing 100730, China.
Abstract:OBJECTIVE: To assess the specificity and sensitivity of antiperinuclear factor (APF), anti-keratin antibody (AKA), anti-Sa antibody and anti-RA33 antibody in the diagnosis of RA. METHODS: 128 patients with RA, whose durations were within 1 year, were included. APF and AKA were detected by indirect immunofluorescence on the human buccal mucosa cells and the straum corneum of Wistar rat esophagus. Anti-Sa antibody and anti-RA33 antibody were examined by Western blotting. Sa antigen was extracted from human placenta while RA33 antigen from Ehrlich cells. RESULTS: (1) The specificities and sensitivities of APF, AKA, anti-Sa antibody and anti-RA33 antibody were 91.4% (224/245) & 35.2% (45/128), 90.2% (221/245) & 32.0% (43/128), 90.6% (222/245) & 33.6% (43/128), 89.8% (220/245) & 28.9% (37/128), respectively, versus 72.3% (177/245) & 44.5% (57/128) for rheumatoid factor (RF). There were no statistical differences in the specificity between the four antibody groups and RF until 1:128 were taken as positive titer. Among 71 patients with RF-negative RA, 15 (21.1%) were positive for APF, 18 (25.4%) positive for AKA, 21 (29.6%) positive for anti-Sa antibody and 17 (23.9%) positive for anti-RA33 antibody. (2) Specificity and sensitivity were 95.1% (233/245) and 46.1% (59/128) respectively when two of the four antibodies turned out to be both positive. If three or more kinds were detected simultaneously, specificity was as much as 99.6% (108/128). (3) Statistical difference was found among the four groups defined by the number of positive antibodies in radiographic stage and patients assessment of illness. CONCLUSION: (1) Dictation of APF, AKA, anti-Sa antibody and anti-RA33 antibody can greatly improve the specificity of diagnosis of early RA and serve as a complement when RF is negative. (2) Combined detection of the above four antibodies has a better discrimination ability as a laboratory criterion than that of RF. (3) Three or more positive antibodies may be an indicator of severe bone erosion and emergent demand for early treatment with better outcome.
Keywords:Arthriris  infectious  Antibody  Diagnosi
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