血清抗角蛋白抗体、抗核周因子和抗环瓜氨酸肽抗体在幼年类风湿关节炎应用中的评价

目的评价抗角蛋白抗体（AKA）、抗核周因子（APF）和抗环瓜氨酸肽抗体（anti-CCP）在幼年类风湿关节炎（JRA）应用中的意义。方法收集76例JRA及54例非JRA患儿,健康对照30例血清,测定其AKA、APF和抗CCP水平,对JRA诊断敏感性、特异性进行评价,并对JRA患儿中3种抗体阳性和阴性组的临床症状、体征及实验室检查指标进行比较,并作统计学分析。结果AKA、APF和抗CCP及联合检测ROC曲线下面积略高于0.5,但Pa〉0.05。单一抗体检测灵敏度为30%～50%,联合检测灵敏度无增加。单一抗体检测的特异度为50%～80%,联合检测特异度增加至80%～85%。JRA组AKA（＋）病例较多出现关节强直,心包积液,骨质稀疏,肺炎支原体抗体阳性率相对高,且ASO、ESR、CRP水平较高,Pa〈0.05;APF（＋）病例较多出现关节强直,骨质稀疏,肺炎支原体抗体阳性率相对高,而且ASO、ESR、CRP水平较高,有显著差异（P〈0.05）,抗CCP（＋）病例与抗CCP（-）病例比较,在临床表现、实验室检查方面无显著差异。结论AKA、APF、抗CCP抗体对JRA缺乏早期诊断意义及特异性,AKA、APF对判断疾病的活动性、病理损害程度和预后有临床意义。

Evaluation of Clinical Usefulness of Antikeratin Antibody, Antiperinuclear Factor and Anti-Cyclic Citrullinated Peptide Antibody in Juvenile Rheumatoid Arthritis

Objective To evaluate the usefulness of antikeratin antibody(AKA),antiperinuclear factor(APF)and anti-cyclic citrullinated peptide antibody(anti-CCP)in distinguishing juvenile rheumatoid arthritis(JRA).Methods Seventy-six children with JRA were compared with 54 children with non JRA diseases and 30 healthy children.They were admitted during the same period and blood samples were collected for the study.Results There were no significant demographic differences among 3 groups.Sensitivity of each individual antibody was 30%-50% and combination could not increase the sensitivity.Specificity of each antibody was 50%-80% and combination increased the specificity to 80%-85%.ROC curve was performed to each antibody and combination.The areas under the ROC curve were only slightly over 0.5 and not significant.In JRA group,compared with AKA-negative children,more AKA-positive children presented joint stiffness,pericardial effusion,osteoporosis and antibody-positive of mycoplasma pneumoniae;they had higher ASO,ESR and CRP in the same group,compared with APF-negative children,more APF-positive children presented joint stiffness,osteoporosis and antibody-positive of mycoplasma pneumoniae;they had higher ASO,ESR and CRP.There was no significant difference in clinical symptoms,signs and laboratory examinations between anti-CCP positive and negative patients.Conclusions AKA,APF and anti-CCP can not improve early diagnostic sensitivity to JRA patients.AKA and APF have clinical value to estimate disease activity,pathology injury and prognosis.