抗CCP抗体和AKA在类风湿关节炎诊断的应用价值

目的 比较抗环瓜氨酸肽抗体(抗CCP抗体)和抗角蛋白抗体(AKA)在类风湿关节炎诊断中作用,探讨RA的早期诊断方法.方法 对已确诊的85例RA患者、74例非RA的自身免疫病患者同时测定抗CCP抗体(ELISA法)、AKA(间接免疫荧光检测).结果 抗CCP抗体对诊断RA的灵敏度和特异性分别为75.3％和93.2％;AKA对RA诊断的灵敏度和特异性分别为89.4％和85.14％.抗CCP抗体的灵敏度与AKA灵敏度差异无统计学意义(P＞0.05),特异性差异有统计学意义(P＜0.05);抗CCP抗体或AKA与二者联合检测的灵敏度差异有统计学意义(P＜0.05),特异性差异有统计学意义(P＜0.05).阳性预测值抗CCP抗体较高,阴性预测值以二者联合检测较好,Youden index二者联合检测比单独检测抗CCP抗体或AKA高.抗CCP抗体和AKA在检测RA组中抗CCP抗体和AKA同时阳性检出58例;抗CCP抗体或AKA阳性共检出85例.抗CCP抗体或AKA阳性率(96.5％)比二者同时阳性率(68.2％)大大提高.结论 抗CCP抗体、AKA对RA具有较好的灵敏度和高度的特异性,联合检测抗CCP抗体和AKA可作为早期RA患者及RF阴性RA患者的早期诊断指标.

Anti-CCP and Anti-AKA Application Value in the Diagnosis of Rheumatoid Arthritis

Objective To compare the diagnostic value of anti-CCP and anti-AKA in rheumatoid arthritis and to explore the early diagnosis of rheumatoid arthritis (RA).Methods The anti-CCP(ELISA) and anti-AKA (indirect immunofluorescence assay) were used in 85 patients with RA and 74 patients with non-RA.Results The sensitivity and specificity of anti-CCP for the diagnosis of RA were 75.3％ and 93.2％.The sensitivity and specificity of anti-AKA were 89.4％ and 85.1％.There was no significant difference on the sensitivity of between anti-AKA and anti-CCP (P ＞ 0.05).On the specificity of anti-AKA,the difference was significant(P ＜ 0.05).The difference on sensitivity of anti-CCP and antAKA combined detection was statistically significant (P ＜ 0.05).The specificity of anti-CCP and anti-AKA combined was statistically significant (P ＜ 0.05).Anti-CCP antibodies were higher for positive predictive value,combined detection of both offered high negative predictive value.Youden index on combined detection of anti-CCP or anti-AKA was higher than tested.Anti-CCP and anti-AKA were detected in 58 cases,anti-CCP or AKA positive in 85 cases.The positive rate of anti-CCP or anti-AKA(96.5％) was significantly higher than that(68.2％).Conclusion Anti-CCP and anti-AKA have higer sensitivity and specificity for diagnosis of RA.Combined detection of anti-CCP and anti-AKA can be used as good diagnostic indicators for early RA patients and RF negative RA patients.