抗环瓜氨酸肽抗体联合类风湿因子IgA和IgM诊断类风湿关节炎的临床价值

目的评估单独或联合检测抗角蛋白抗体（AKA）、抗环瓜氨酸肽（CCP）抗体、类风湿因子（RF）IgA和IgM对类风湿关节炎（RA）的诊断价值。方法分别检测195例RA患者和195例对照者血清中的AKA、抗CCP抗体、IgA-RF和IgM-RF，AKA采用间接免疫荧光的方法检测，抗-CCP抗体、IgA-RF和IgM-RF采用酶联免疫吸附试验检测，分析上述抗体在RA中的敏感性和特异性，比较抗-CCP抗体联合IgA-RF或（和）IgM-RF诊断RA的敏感性、特异性、阳性预测值和阴性预测值。结果抗-CCP抗体、IgA-RF和IgM-RF3项联合检测特异性最高。抗-CCP抗体＋IgA-RF的阳性预测值（87．59％）要明显高于抗CCP抗体＋IgM-RF（78．49％）。结论抗CCP抗体与IgA／IgM-RF联合检测可以显著提高RA的诊断效能，降低误诊率。

Clinical value of anti-cyclic citrullinated peptide antibody combined with rheumatoid factor IgA and IgM for diagnosing rheumatoid arthritis

Objective To evaluate the value of the single or combined detection of anti keratin antibody （AKA） ,anti-cyclic citrullinated peptide（CCP） antibody and rheumatoid factor（RF） for the diagnosis of rheumatoid arthritis（RA）. Methods Serum AKA,anti CCP antibody,IgA-RF and IgM-RF were detected in 195 cases of RA and 195 controls. AKA was detected by using the indirect immunofluorescence method,RF and anti-CCP antibody were detected by using ELISA. The specificity and sensitivity of those antibodies in RA were analyzed in the diagnosis of RA. The sensitivity, specificity, positive predictive value（PPV） and negative predictive value（NPV） of anti-CCP anti- body combined IgA-RF and/or IgM-RF for diagnosing RA were compared. Results The combination detection of an- ti-CCP antibody, IgA-RF and IGM-RF had the highest specificity. The positive predictive value of anti-CCP antibody ＋ IgA-RF was 87. 59%,which was significantly higher than 78.49% of anti CCP antibody＋IGM-RF. Conclusion The combined detection of anti CCP antibody and IgA/IgM-RF can significantly improve the diagnostic efficiency and reduce the misdiagnosis rate.