抗瓜氨酸化蛋白／肽抗体对类风湿关节炎的诊断价值

目的探讨4种抗瓜氨酸化蛋白，肽抗体（anti-citrufllinated protein／peptide autoantibodies，ACPAs）-抗核周因子（anti-perinuclear fator，APF）、抗角蛋白抗体（anti-keratin antibody，AKA）、抗角蛋白微丝聚集蛋白抗体（antiprofillagrin／fillagrin antibody，AFA）、第二代抗环瓜氨酸肽抗体（second generation of anti-cylic citrulline peptide antibody，CCPⅡ）对类风湿关节炎（rheumatoid arthritis，RA）的诊断意义及其结果的一致性。方法 对129例RA、153例其他风湿性疾病患者和94名健康对照者的血清进行类风湿因子（rheumatoid factor，RF）和ACPAs检测。RF采用乳胶间接凝集法检测。APF和AKA采用间接免疫荧光法检测，AFA、抗CCP（Ⅱ）抗体采用酶联免疫吸附法检测。结果APF、AKA、AFA和抗CCP（Ⅱ）抗体对RA的诊断特异性分别为90.3％、94．7％、93．5％和94．7％，敏感性分别为58．1％、40.3％、62．0％和67．4％；而RF的诊断特异性和敏感性为77．7％和46．5％。APF与AFA、APF与抗CCP（Ⅱ）和AFA与抗CCP（Ⅱ）抗体间检测结果一致性较好，Kappa值分别是0．596、0．572和0．576。结论ACPAs是RA的诊断特异性抗体，其中抗CCP（Ⅱ）抗体的敏感性和特异性最高，且与APF和AFA抗体间结果具有明显的一致性。

Comparasion of Diagnostic Values of Anti-citrullinated Protein/Peptide Autoantibodies in Rheumatoid Arthritis

To analyze the diagnostic value and relationship of anti-citrullinated protein/peptide autoantibodies （ACPAs） -anti-perinuclear fator （APF）, anti-keratin antibody （AKA）, anti-profillagrin/fillagrin antibody （AFA）, and second generation of anti-cylic citrulline peptide antibody （anti-CCP Ⅱ ） in rheumatoid arthritis （RA）. Methods Three hundred and seventy-six serum samples, including 129 RA cases, 153 non-RA rheumatic disease cases, and 94 healthy subjects were enrolled. Rheumatoid factor （RF） was detected by latex agglutination test. APF and AKA were detected by indirect immunofluores- cence test. AFA and anti-CCP （Ⅱ） antibody were measured by enzyme linked immunosorbent assay test. Results The sensitivities of RF, APF, AKA, AFA, and anti-CCP （Ⅱ） for RA were 46.5%, 58.1%, 40.3%, 62.0%, and 67.4% respectively, their specificities were 77.7%, 90.3%, 94.7%, 93.5%, and 94.7%respectively. The Kappa values between APF and AFA, APF and anti-CCP （Ⅱ） antibody, AFA and anti-CCP （II） antibody were 0.596, 0.572, and 0.576 respectively. Conclusion Among ACPAs, anti-CCP （Ⅱ） antibody was the most sensitive and specific item for RA and had good con-sistency with APF and AFA.