自身抗体阴性类风湿关节炎的临床及实验室特点

目的 探讨自身抗体阴性类风湿关节炎（rheumatoid arthritis，RA）的临床及实验室特点。方法 分析247例RA患者，比较自身抗体阴性RA（30例）与抗体阳性RA的临床及实验室特点，以骨关节炎患者（34例）作为对照组。结果 自身抗体阴性的RA占12．1％（30／247），自身抗体阴性RA患者的晨僵时间较自身抗体阳性RA患者短（P〈0．05）；血清免疫球蛋白IgG、IgA及γ球蛋白比率水平显著低于自身抗体阳性RA患者（P〈0．01）。而自身抗体阴性RA患者的红细胞沉降率（ESR）、C反应蛋白（CRP）、免疫球蛋白IgM、γ球蛋白比率均明显高于骨关节炎患者（P〈0．05），同时与骨关节炎患者比较，其血红蛋白降低及血小板升高的幅度更明显（P〈0．05）。结论 RA患者中自身抗体阴性者占12．1％．提示自身抗体阴性RA并不少见。ESR、CRP、免疫球蛋白IgM及γ球蛋白的增高在自身抗体阴性RA的诊断中有参考意义。     

抗环瓜氨酸多肽抗体阴性类风湿关节炎的临床特点分析

目的:分析抗CCP抗体阴性RA患者的临床特点。方法:回顾性分析2013年1月至2018年12月于北京大学第三医院风湿免疫科病房住院的RA患者的病历资料,收集患者的一般情况,关节表现,关节外表现以及实验室检查结果,使用 U检验和 χ2检验比较抗CCP抗体阴性与抗CCP抗体阳性RA患者临床特点的差异...     

自身抗体阴性自身免疫性肝炎患者临床病理学特点

目的:分析自身抗体阴性自身免疫性肝炎(AIH)患者临床特点,并总结诊疗经验。方法:对167例AIH患者的临床和病理特点进行分析,将自身抗体阴性AIH患者定义为:符合国际自身免疫性肝炎小组(IAIHG)1999年描述性诊断标准且抗核抗体、抗平滑肌抗体、抗肝肾微粒体1型抗体和抗线粒体抗体均为阴性者。结果:167例中17例自身抗体阴性,占10.2%。自身抗体阳性和自身抗体阴性AIH患者在一般情况(诊断时年龄除外)、生化指标方面均无明显差异(P0.05)。自身抗体阴性组血清IgG水平低于自身抗体阳性组,差异有统计学意义(P=0.004)。两组肝组织学炎症分级无明显差异,而自身抗体阴性组中存在更多纤维化进展期患者(P0.001)。采用1999年诊断积分系统评估时,自身抗体阴性组中11例(64.7%)为可能性诊断,其余6例(35.3%)为确定性诊断;采用简化诊断积分系统重新评估后,仅3例(17.6%)达到可能性诊断,且无1例达到确定性诊断标准。与自身抗体阳性组相比,自身抗体阴性AIH患者接受24个月的免疫抑制治疗后累积完全生化缓解率为86%,两组患者无明显差异(P=0.658)。结论:自身抗体阴性AIH在国人中并非罕见,在应用免疫抑制治疗方面与自身抗体阳性AIH患者类似,能取得满意疗效。     

抗p68抗体的检测及其在类风湿关节炎中的意义

目的建立抗p68抗体的检测方法,并研究其在类风湿关节炎(RA)中的意义。方法以Hela细胞为底物,采用间接免疫荧光法,检测183例RA病人及114例其他结缔组织病和81名正常人血清中的抗p68抗体,并分析该抗体与RA的临床及实验室指标的相关性。结果①183例RA患者中,抗p68抗体的阳性率为67.8%(124/183),114例非RA风湿病患者中阳性率为14.9%(17/114),81名正常人中无一例阳性(0/81)。②抗p68抗体对RA的敏感性和特异性分别为67.8%和91.3%。阳性预测值为87.9%,阴性预测值为75.1%。③抗p68抗体阳性的RA患者与抗p68抗体阴性的患者在病程、类风湿因子(RF)、双手X线分期等因素差异有显著性(P<0.05)。结论①该抗体是一种对RA诊断较为特异的新型自身抗体。②该抗体与病程、RF、双手X线分期等相关。     

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.     

自身抗体阳性的慢性乙型肝炎患者血清HBV标记物特点分析

目的分析自身抗体阳性的慢性乙型肝炎患者血清学和病毒学特点,为临床抗病毒治疗提供参考。方法回顾性分析比较自身抗体阳性的CHB患者107例和自身抗体阴性的CHB患者75例的临床资料。结果两组患者ALT和AST水平、HBeAg阳性率和HBV DNA定量比较,均无统计学差异（P〉0.05）;自身抗体阳性的CHB患者HBsAg水平为260.12±54.40U/ml,明显高于自身抗体阴性的CHB患者（244.21±51.15U/ml,P〈0.05）;自身抗体阳性的CHB患者HBV基因C型所占比例为55.07%（38/69）,明显高于自身抗体阴性的CHB患者（27.11%,P〈0.05）。结论自身抗体阳性的CHB患者自身抗体的产生与基因型可能有一定的关系。     

类风湿关节炎患者抗环瓜氨酸抗体、HLA—DR4基因与其临床特征的关系

目的 探讨抗环胍氨酸（CCP）抗体、人类白细胞抗原HLA-DR4基因与进展性类风湿关节炎（RA）临床特征的关系.方法 记录73例类风湿关节患者的临床资料和实验室检查结果,并采用细胞毒法检测全部病例的HLA-DR4基因携带情况,比较HLA-DR4阳性组与阴性组的临床表现、实验室指标、X线表现及关节功能分级.结果 HLA-DR4阳性者27例,基因频率为37%.HLA-DR4阳性组关节肿胀指数、疼痛指数较高,晨僵持续时间较长,关节功能分级为Ⅲ～Ⅳ级的比例较高,出现骨质破坏比例也较高,抗CCP抗体、类风湿因子、血沉、C反应蛋白值均高于阴性组.结论 HLA-DR4和抗CCP抗体阳性的RA患者与HLA-DR4阴性组的RA患者比较炎症活动严重,且进展较快,应积极治疗.     

抗环瓜氨酸肽抗体阳性和阴性类风湿关节炎患者外周血单个核细胞基因表达谱差异的研究

目的 运用基因芯片技术研究抗环瓜氨酸肽(CCP)抗体阳性和阴性类风湿关节炎(RA)患者外周血单个核细胞(PBMC)基因表达谱差异,探索差异存在的基因表达基础.方法 提取各5例抗CCP抗体阳性、阴性RA患者、健康人PBMC中总RNA,运用Ⅲumina基因表达谱芯片分析每个样本47231个基因变化.结果 与健康对照组相比,抗CCP抗体阳性和阴性RA患者有88个差异表达基因,其中上调表达基因51个,下调表达基因37个,这些差异表达基因主要涉及细胞因子、细胞凋亡、细胞周期、细胞因子、信号转导、趋化因子等.抗CCP抗体阳性和阴性RA患者之间有20个基因表达差异有统计学意义,其中上调表达基因9个,下调表达基因11个,这些差异表达基因主要涉及传递蛋白、转录调控、信号转导、代谢、细胞周期等.结论 抗CCP抗体阳性和阴性RA患者之间存在差异表达基因,筛选到的差异基因如杀伤细胞免疫球蛋白受体基因、干扰素诱导基因、几丁质酶家族成员CHI3L1等为进一步研究RA发病机制及发现新治疗靶标提供重要线索.     

类风湿关节炎患者抗CCP抗体检测及与其他实验室指标的关系

目的探讨抗环瓜氨酸肽抗体（抗CCP抗体）在类风湿关节炎（RA）中的诊断价值。方法选择RA患者116例、其他自身免疫病患者79例、健康对照者50例,采用ELISA法行抗CCP抗体检测,并检测RA患者的相关实验室指标。结果抗CCP抗体诊断特异性（94.58%）高于类风湿因子（RF）（68.22%）。进行抗CCP抗体、RF联合检测时,以任一项指标阳性的敏感性高于两者均阳性的敏感性（P〈0.05）。抗CCP抗体阳性的RA患者C反应蛋白（CRP）、血沉（ESR）均高于阴性者（P〈0.01）。结论抗CCP抗体在RA诊断中具有较高特异性,以抗CCP抗体或RF任一种阳性为诊断指标有利于早期诊断RA。抗CCP抗体阳性可能与RA活动性相关。     

类风湿性关节炎患者检测HLA-DR与自身抗体的临床意义

目的探讨类风湿关节炎（RA）患者与HLA-DR基因及自身抗体的相关性及临床意义。方法研究对象为235例RA患者及50例健康体检者,采用PCR-SSP法检测HLA-DR4和HLA-DR53基因分型;ELISA法检测抗CCP、RA33抗体。结果 RA患者HLA-DR4和HLA-DR53等位基因发生的频率数分别为42.98%和56.60%,组间及与对照组比较均有统计学差异（P〈0.01）,与RA的相对危险率分别为3.96和2.77;RA患者抗CCP、RA33抗体分别为72.34%和37.44%,组间及与对照组比较均有统计学差异（P〈0.01）。RA患者在患病率不变的情况下,HLA-DR4特异性、阳性预测值、阳性似然比和阴性似然比均高于HLA-DR53,抗CCP抗体敏感性和特异性等指标高于抗RA33抗体。结论 HLA-DR4基因与RA的发生易感性明显相关,联合检测抗CCP、RA33抗体可提高RA的诊断率。     

Autoantibodies in early seropositive rheumatoid arthritis,before and during disease modifying antirheumatic drug treatment

OBJECTIVE: Autoantibodies observed in patients with rheumatoid arthritis (RA) during clinical trials of immunomodulating agents may cause concern about possible induction of autoimmunity by the therapeutic intervention. We determined the frequency and variability of selected autoantibodies in patients with early rheumatoid factor (RF) positive RA during a prospective observational study. METHOD: The study cohort consisted of 276 patients with active RA and with RF > or = 40 IU, who were enrolled between January 1, 1993, and April 1, 2000, before starting disease modifying antirheumatic drug (DMARD) therapy (average duration of symptoms, 7 mo). During an average of 3.5 years followup, a panel of autoantibodies was determined at entry, 6 months, 12 months, and yearly thereafter, in addition to routine clinical, radiographic, and laboratory assessments. After enrollment, patients were treated with DMARD at the discretion of their rheumatologists. RESULTS: At entry before any DMARD therapy, antinuclear antibody (ANA; by HEp-2) values were negative in 31%, borderline (8 IU/ml) in 26%, and > 8 (mean 65.5 IU/ml) in 41%. Tender and swollen joint counts, Disease Activity Score, and RF values were significantly higher in those with ANA > 8. During followup 726 paired serial specimens were available; 12.5% changed from negative to positive ANA and 12.3% from positive to negative. Additional autoantibodies were present in specimens of 20% of the subjects; 8% had 2 and 1.4% had 3 other autoantibodies. Anti-dsDNA was detected in 13 (5.5%) patients; 4 changed from negative to positive and one from positive to negative. SSA IgG and SSB IgG autoantibodies were both present in one of these patients. Ribosomal P protein autoantibodies were noted in 2 other patients, but Sm (Smith) and uRNP/snRNP IgG autoantibodies were not present in any patient. No patient had a diagnosis of systemic lupus erythematosus. Antithyroid peroxidase (20 patients), parietal cell (15), smooth muscle (14), reticulin (9), mitochondrial (5), striational (2), SSB (2) and SCL-70 (1) autoantibodies were detected in some specimens. Seven patients were diagnosed with hypothyroidism, one with chronic thyroiditis, one with hepatitis C, and 9 with malignancies. CONCLUSION: In patients with early RF positive RA the frequent occurrence of autoantibodies before and during treatment with standard DMARD may make it difficult to attribute their presence to new therapies.     

Detection of autoantibodies to killer immunoglobulin-like receptors using recombinant fusion proteins for two killer immunoglobulin-like receptors in patients with systemic autoimmune diseases

OBJECTIVE: To investigate the existence of autoantibodies to killer immunoglobulin-like receptors (KIRs), especially p58.1 (KIR2DL1) and p58.2 (KIR2DL3), in patients with systemic autoimmune diseases. METHODS: Sera from 30 patients with systemic lupus erythematosus (SLE), 30 patients with rheumatoid arthritis (RA), 22 patients with Beh?et's disease, and 20 healthy control subjects were tested for anti-p58.1 and anti-p58.2 antibodies by Western blot analysis using recombinant p58.1 and p58.2 proteins. Furthermore, clinical features and laboratory data were compared between the anti-p58.1/58.2 antibody-positive and -negative patients. RESULTS: Anti-p58.1 antibodies were detected in 7 (23.3%) of the 30 patients with SLE, 9 (30%) of the 30 patients with RA, and 6 (27.3%) of the 22 patients with Beh?et's disease. Anti-p58.2 antibodies were detected in the same 22 patients who were positive for the anti-p58.1 antibodies. None of the serum samples from the healthy donors were positive for antibodies to the recombinant p58.1 or p58.2 molecules. Compared with the anti-p58.1/ 58.2 antibody-negative patients, the anti-p58.1/58.2 antibody-positive patients had significantly elevated levels of serum IgG in all 3 diseases tested, an accelerated erythrocyte sedimentation rate in RA and SLE, and decreased white blood cell counts in RA. CONCLUSION: This report is the first to describe the presence of autoantibodies to KIR2DL (p58.1 and p58.2) in the sera of patients with systemic autoimmune diseases. Considering the correlation with several clinical features, these autoantibodies may be involved in the pathologic process of the autoimmune diseases.     

Follow-up of primary Sjogren’s syndrome patients presenting positive anti-cyclic citrullinated peptides antibody

Anti-cyclic citrullinated peptide antibody (anti-CCP antibody) is very useful for the diagnosis of rheumatoid arthritis (RA) and is associated with articular erosions. The specificity of anti-CCP antibody in the diagnosis of RA has been reported to be about 95 %. Because of its higher specificity in RA, we assessed the clinical features of primary Sjogren’s syndrome (pSS) who were positive for anti-CCP antibody. We assessed the clinical features of 405 pSS patients. After 60 (range 7–98) months, 23 (5.6 %) patients previously diagnosed with pSS had progressed to RA. Comparing the anti-CCP positive group with the negative group, laboratory test results for anti-CCP titer and rheumatoid factor positivity with respect to clinical outcome and progression to RA, arthralgia and arthritis were significantly different. Multivariate regression analysis also showed that anti-CCP antibody titer was independently associated with progression to RA. The odds ratio of anti-CCP positivity in terms of progression to RA was 2.5 (95 % CI 1.7–3.7). Testing for anti-CCP antibody in pSS patients with arthritis may allow for the prediction of progression to RA.     

Detection of autoantibodies to killer immunoglobulin‐like receptors using recombinant fusion proteins for two killer immunoglobulin‐like receptors in patients with systemic autoimmune diseases

Objective

To investigate the existence of autoantibodies to killer immunoglobulin‐like receptors (KIRs), especially p58.1 (KIR2DL1) and p58.2 (KIR2DL3), in patients with systemic autoimmune diseases.

Methods

Sera from 30 patients with systemic lupus erythematosus (SLE), 30 patients with rheumatoid arthritis (RA), 22 patients with Behçet's disease, and 20 healthy control subjects were tested for anti‐p58.1 and anti‐p58.2 antibodies by Western blot analysis using recombinant p58.1 and p58.2 proteins. Furthermore, clinical features and laboratory data were compared between the anti‐p58.1/58.2 antibody–positive and –negative patients.

Results

Anti‐p58.1 antibodies were detected in 7 (23.3%) of the 30 patients with SLE, 9 (30%) of the 30 patients with RA, and 6 (27.3%) of the 22 patients with Behçet's disease. Anti‐p58.2 antibodies were detected in the same 22 patients who were positive for the anti‐p58.1 antibodies. None of the serum samples from the healthy donors were positive for antibodies to the recombinant p58.1 or p58.2 molecules. Compared with the anti‐p58.1/58.2 antibody–negative patients, the anti‐p58.1/58.2 antibody–positive patients had significantly elevated levels of serum IgG in all 3 diseases tested, an accelerated erythrocyte sedimentation rate in RA and SLE, and decreased white blood cell counts in RA.

Conclusion

This report is the first to describe the presence of autoantibodies to KIR2DL (p58.1 and p58.2) in the sera of patients with systemic autoimmune diseases. Considering the correlation with several clinical features, these autoantibodies may be involved in the pathologic process of the autoimmune diseases.

     

Survivin improves the early recognition of rheumatoid arthritis among patients with arthralgia: A population-based study within two university cities of Sweden

ObjectivesThe aim of this study was to validate the use of survivin for preclinical recognition of rheumatoid arthritis (RA) among patients with unexplained arthralgia.MethodsSerum levels of survivin and the arthritis-specific autoantibodies RF and ACPA were measured in total of 5046 patients with musculoskeletal complains during 12 consecutive months in Gothenburg and in Umeå. Among them, 303 arthralgia patients were identified and prospectively followed.ResultsAfter 48 months, 12.2% of the arthralgia patients developed RA. Most of RA cases had high serum survivin, which increased the relative risk for RA (RR = 5.90, p = 3 × 10⁻⁷). Combination of survivin with autoantibodies was present in only 4.6% of the arthralgia patients and increased further the risk of RA and shortened time to RA development. Presence of any single autoantibody in the survivin-negative patients was associated with a minor risk for RA and had RA-free survival similar to the reference group.ConclusionThis study shows that measurement of survivin in serum improves estimation of RA risk and prospectively predicts RA development in patients with arthralgia. Survivin may indicate a phase preceding autoantibody production.     

类风湿关节炎血清学早期诊断

目的 探索抗核周因子（ＡＰＦ）、抗角蛋白抗体（ＡＫＡ）、抗Ｓａ抗体及抗ＲＡ３３／３６抗体检测对ＲＡ的早期诊断价值。方法 对未肯定诊断的关节痛／关节炎病人１１６例进行上述四种抗体检测并随访观察。ＡＰＦ和ＡＫＡ用间接免疫荧光法进行检测。抗Ｓａ抗体和抗ＲＡ３３／３６抗体用免疫印迹法检测。结果 对１１６例未肯定诊断的关节痛／关节患者随访４￣１８个月。ＡＰＦ阳性的２９例中,最后确诊为ＲＡ２０（６９％）;ＡＫ     

Presenting features of polymyalgia rheumatica (PMR) and rheumatoid arthritis with PMR-like onset: a prospective study

OBJECTIVE: To evaluate in a prospective study whether patients with polymyalgia rheumatica (PMR) and patients with rheumatoid arthritis (RA) with PMR-like onset show distinctive clinical and laboratory features. METHODS: A cohort of 116 consecutive patients with bilateral girdle pain for at least one month and raised erythrocyte sedimentation rate (ESR) was studied and followed up for 12 months. Laboratory tests included determination of ESR, IgM rheumatoid factor, haemoglobin, white blood cell count, platelet count, percentage of CD8 lymphocytes, serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and glutamyltransferase concentrations. RESULTS: At first examination, RA was diagnosed in 22/116 (19%) patients and PMR in 94 (81%) patients. During the follow up period, 19 additional patients developed RA, and the diagnosis of PMR was confirmed in 65 (56%) patients at the end of the study. Of the clinical and laboratory features, only the presence of peripheral synovitis could differentiate patients who will develop RA from those with "true" PMR, but the positive predictive value of this feature was poor. CONCLUSION: At present, there are no clinical or routine laboratory features allowing early differentiation between PMR and RA with PMR-like onset.     

Increased incidence of autoantibodies to interleukin-1a in rheumatoid arthritis with interstitial lung disease

OBJECTIVE: To clarify the clinical significance of autoantibodies (auto-Ab) to interleukin-1alpha (IL-1alpha) in rheumatoid arthritis (RA) with interstitial lung disease (ILD), we examined the IL-1alpha auto-Ab level in serum of patients with RA with/without ILD. METHODOLOGY: We investigated the level of IL-1alpha auto-Ab in serum of 70 patients with RA with/without ILD and 40 control patients (CP). Levels of IL-1alpha auto-Ab were measured by radioimmunoassay, and serum was regarded as IL-1alpha auto-Ab positive at an auto-Ab level of more than 5 ng/mL. RESULTS: Interleukin-1alpha auto-Ab was detected in the serum of 30 out of 70 RA patients (42.9%), and six out of 40 CP (15%) (P < 0.05). Interleukin-1alpha auto-Ab were detected in the serum of 18 out of 32 patients with RA with ILD (56.2%) and 12 out of 38 patients with RA without ILD (31.5%). The positive rate of these autoantibodies in RA with ILD was significantly higher than that in RA without ILD (P < 0.05). Although C-reactive protein, immunoglobulin G, rheumatoid factor and rheumatoid arthritis particle agglutination levels in serum from patients with RA with ILD were not significantly different between the IL-1alpha auto-Ab-positive and -negative groups, the lactate dehydrogenase level (LDH) and AaDO, in the IL-1alpha auto-Ab-positive group were significantly higher than those in the negative group (LDH: P < 0.001, AaDO2: P < 0.05). CONCLUSION: These results suggest that IL-1alpha auto-Ab are generated in response to the immunoinflammatory process of ILD in RA, and these autoantibodies may neutralize and regulate the IL-1alpha activity.     

High Frequencies and co-existing of myositis-specific autoantibodies in patients with idiopathic inflammatory myopathies overlapped to rheumatoid arthritis

A small proportion of patients with rheumatoid arthritis (RA) develop idiopathic inflammatory myopathies (IIM); however, the clinical and immunological characteristics of these patients have not been elucidated. In the present study, we evaluate the frequency of autoantibodies and the accompanying clinical features in patients with IIM overlapped to RA (IIM-RA) and in patients with IIM without RA. Twelve patients with IIM-RA were selected from 142 patients with IIM who were admitted to our hospital. Clinical and laboratory data, including autoantibody test results, were collected from patient medical records. Myositis-specific antibodies (MSAs) were analyzed by immunoprecipitation. Clinically, patients with IIM-RA were more likely to be male, to have polymyositis, and to be older at the time of IIM onset than patients with IIM without RA. Patients with IIM-RA had been treated for 2–25?years prior to the onset of IIM with more than two disease-modifying antirheumatic drugs (DMARDs). Patients with IIM-RA had a high frequency (75.0%) of positivity for MSAs, including anti-Jo-1, anti-PL-7, anti-PL-12, or anti-signal recognition particle (SRP) antibodies; anti-Jo-1 antibody was detected in 4 patients (33.3%). In addition, 2 out of 12 patients with IIM-RA were concurrently positive for two different MSAs, anti-Jo-1, and anti-PL-7 antibodies. In 3 other patients with IIM-RA, anti-Jo-1 antibody, or anti-PL-7 antibody was detected in serum samples collected 6–18?months prior to development of myositis. High frequency and coexistence of MSAs were detected in patients with IIM-RA. MSAs detected in patients with RA even without symptoms of myositis may indicate possible future development of myositis.     

抗角蛋白抗体在类风湿关节炎的临床意义

目的研究抗角蛋白抗体(AKA)在类风湿关节炎(RA)的临床意义。方法98例RA患者及70例其他风湿性疾病患者测定血清抗角蛋白抗体,对两组病人AKA阳性率进行比较,并对抗角蛋白抗体与类风湿因子(RF)对RA诊断的敏感性和特异性进行比较,同时对RA患者AKA阳性组和AKA阴性组的关节肿胀指数、关节压痛指数、握力、晨僵时间、休息痛和RF、血沉、C反应蛋白、影像学检查以及关节外表现等临床指标进行比较,对资料进行统计分析。结果RA患者AKA阳性率明显高于其他风湿性疾病患者(P<0.001);AKA对于RA诊断较RF更具特异性;RA患者中AKA阳性组较AKA阴性组病情严重,除握力外各项观察指标比较均有统计学意义(P<0.05)。结论AKA检测对RA诊断、病情预测和指导治疗均有较高的临床价值。