类风湿因子阴性类风湿关节炎的临床诊断研究

目的:研究4种自身抗体及影像学检查对类风湿因子(RF)阴性类风湿关节炎(RA)的临床诊断价值。方法:选择260例RF阳性和252例RF阴性RA患者,分别进行血清学抗核周因子(APF)、抗角蛋白抗体(AKA)、抗RA33抗体、抗Sa抗体检测和MRI、X线检查,应用统计学方法对两组各项指标的阳性率及RA检出率进行比较。结果:RF阳性组APF、AKA、抗RA33抗体、抗Sa抗体阳性率分别为73.08%、72.69%、48.85%、47.69%;RF阴性组阳性率分别为69.84%、68.65%、54.76%、42.86%,两组差异无显著性意义(P>0.05);MRI、X线检查对RF阳性组和RF阴性组的检出率均为100.00%,两组差异无显著性意义(P>0.05)。结论:APF、AKA、抗RA33抗体、抗Sa抗体检测对诊断RF阴性RA具有较高敏感性和特异性,将上述抗体选择性的与RF进行联合检测,在一定程度上可弥补RF对RA诊断的不足。此外,X线和MRI检查对发现RA相关骨与关节损害均较灵敏。

Clinical Diagnostic Research on RF-negative and the Positive Diagnosis of Rheumatoid Arthritis

Objective: To study the clinical diagnostic value of 4 methods of autoantibody and imageology in rheumatoid factor(RF)-negative patients with rheumatoid arthritis(RA).Methods:260 cases with RA and RF-positive and 252 cases with RF-negative RA,serological anti-nuclear factor(APF),anti-keratin antibody(AKA),anti-RA33 antibody,anti-Sa antibody detection and MRI,X-ray inspection,the application of statistical methods in the two groups indicating positive rate and RA detection rate were statistically compared.Results: RF-positive group,APF,AKA,anti-RA33,anti-Sa antibody positive rate were 73.08%,72.69%,48.85%,47.69%;RF-negative RA positive rate were 69.84%,68.65%,54.76%,42.86%.Difference between the two groups was not statistically significant(P>0.05);MR,X-ray examination of RF-positive group and RF-negative group was found in 100%,with no significant difference between the two groups(P>0.05).Conclusion:APF,AKA,anti-RA33,anti-Sa antibodies in the diagnosis of RF-negative RA with RF-positive RA with the same sensitivity and specificity of clinical selective detection,as laboratory diagnosis of RA indicators,to a certain extent,compensate for RF and RA diagnosis of the deficiencies.Besides,X-ray and MRI examinations are comparatively sensitive to detect bone and joint damage.