类风湿因子和抗环瓜氨酸肽抗体对类风湿关节炎早期诊断的意义及疾病活动的相关性

目的比较类风湿因子（RF）和抗环瓜酸抗体（ACCP）在类风湿关节炎（RA）的早期诊断及预测疾病活动性中的价值。方法采用酶联免疫吸附法（ELISA）、速率散射比浊法检测RF和ACCP，比较它们单独或联合诊断RA的价值．分析RF和ACCP与疾病活动性的相关性。结果ACCP对RA诊断的敏感度为80．2％，特异度为94．8％．ACCP＋RF-IgG＋RF-IgA＋RF-IgM联合检测的敏感度为49．6％，特异度为100．0％；ACCP在RA的非常早期、早期、中晚期的检测值分别为（123．56±98．45）、（193．28±113．46）、（349．49±104．65）RU／mL，随着疾病的进展，其检测值有增高的趋势，差异有统计学意义（F=5．189，P〈0．05），而RF-IgG、RF-IgM、RF-IgA在不同疾病分期中差异无统计学意义（F=1．287、1．547、1．368，P〉0．05）。ACCP和RF滴度与DAS28评分呈正相关（r=0．286、0．243，P〈0．05），与血沉、X线分期、病程均无相关性（P〉0．05）。结论RF联合ACCP应用可进一步提高RA早期诊断的准确性．RF和ACCP与RA疾病活动性密切相关。

Clinical significance of early diagnosis of rheumatoid factor and anti- cyclic citrullinated peptide antibodies for rheumatoid arthritis and its correlation with disease activity

Objective To compare the clinical significance of early diagnosis and disease activity prediction of rheuma- toid factor （RF） and anti-cyclic citrullinated peptide antibodies （ACCP） for rheumatoid arthritis （RA）. Methods RF and ACCP were detected with enzyme linked immunosorbent assay （ELISA） and rate nephelometry. The diagnosis value of them alone or in combination with RA were compared, and the correlation of RF, ACCP and the activity of disease were analyzed. Results The sensitivity of ACCP diagnosis of RA was 80.2%, specificity was 94.8%, the sensitivity of ACCP＋ RF-IgG＋ RF-IgA＋ RF-IgM joint detection diagnosis of RA was 49.6%, specificity was 100.0%. In the very early, early, middle and late of RA, ACCP values were （123.56±98.45）, （193.28±113.46）, （349.49±104.65） RU/mL, re- spectively. With the progress of the disease, the detected value increased, the difference was statistically significant （F = 5.189, P 〈 0.05）, while RF-IgG, RF-IgM, RF-IgA in the staging of disease without significant differences （F = 1.287, 1.547, 1.368; P 〉 0.05）. ACCP and RF titers were positively correlated with DAS28 score （r = 0.286, 0.243, P 〈 0.05）, and erythrocyte sedimentation rate, X-ray stage, course of disease were not correlated （P 〉 0.05）. Conclusion RF com- bined with ACCP can be used to improve the accuracy of the early diagnosis of RA, RF and ACCP are closely related to RA disease activity.