AFA、抗CCP抗体RF对类风湿关节炎诊断及病情评估的意义

目的：①检测类风湿关节炎（RA）病人血清抗聚角蛋白微丝蛋白抗体（AFA）、抗环瓜氨酸肽（CCP）抗体厦类风湿因子（RF），比较单独检测和联合检测对RA诊断的敏感性、特异性、阳性预测值。②比较AFA、抗CCP抗体阳性组与阴性组间关节指数、晨僵时间、血沉（ESR）、C反应蛋白（CRP）、X线骨侵蚀之间的关系。③分析引起骨侵蚀的危险因素。方珐：RA组92例血清标本来自2003—10～2005-01就诊于内蒙古医学院附属医院内科门诊及住院病人。AFA、抗CCP抗体用酶联免疫吸附法（ELISA），RF、CRP用液相终点散射沉淀法。结果：①AFA、抗CCP抗体阳性率与对照组有统计学意义（P〈0．05）。②AFA、抗CCP抗体、RF联合检测的敏感性降低，特异性、阳性预测值较单独检测明显升高（P〈0．05）。③AFA、抗CCP抗体阳性组病情活动指标与阴性对照组差异有统计学意义（P〈0.05），抗CCP抗体阳性是RA发生骨侵蚀的危险因素之一。结论：抗CCP抗体、AFA有共同的抗原决定簇，存在相关性，但不完全重叠。临床上与RF联合检测有助于提高RA的早期诊断、预测病情的活动性厦严重程度，具有广泛的临床应用前景。

THE MEANING OF DIAGNOSIS AND CONDITION VALUATION OF AFA, ANTI-CCP ANTIBODY AND RF TO RHEUMATOID ARTHRITIS

Objective: (1) To compare the sensitivity,specificity,and positive prognosticative value in the diagnosis of rheumatoid arthritis(RA) by examining antifilaggrin antibody(AFA),anticyclic citrullinated peptide(anti-CCP) antibody and rheumatoid factor(RF) respectively simultaneously.(2) To compare the relationship between RA patients who were positive to AFA,anti-CCP antibody with those who were in jointindex,morning stiffness time,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP) and X-ray bone erosion negative.(3) To analyze the dangerous factors leading to bone erosion.Methods: Sera samples of anti-CCP antibody and AFA from 92 patients with RA,who had received treatment in Affiliated Hospital from Oct.2003 to Jan.2005,were detected by enzyme-linked immuno sorbent assay(ELISA).RF and CRP were examined by liquid-phase immunoprecipitation assay with luplulometric end-point detection.Results: (1) Compared with control group,anti-CCP antibody and AFA in RA group have statistical significance in positive rate($P$<0.05).(2) The sensitivity reduced when AFA,anti-CCP antibody and RF detected simultaneously whearas the specificity and positive prognosticative value increased.(3) The activity index between groups with AFA,anti-CCP antibody positive and negative have statistical difference($P$<0.05).Anti-CCP antibody positive is a risk factor for bone erosion with RA. Conclusion: AFA,anti-CCP antibody have common antigen cluster and associated with each other,but incompletely overlap.These antibodies were detected simultaneously,which may improve the early diagnostic rate of RA and prognosticate the activity and severe degree in RA.