联合检测血清中葡萄糖6磷酸异构酶、抗环瓜氨酸肽抗体及类风湿因子对中国汉族早期类风湿关节炎的诊断价值

目的探讨联合检测血清中葡萄糖6磷酸异构酶（GPI）、抗环瓜氨酸肽抗体（抗CCP抗体）及类风湿因子（RF）对中国汉族早期类风湿关节炎（RA）的诊断价值。方法分别在116例中国汉族早期RA患者及100例健康人中对GPI、抗CCP抗体与RF进行测定。其中GPI及抗CCP抗体的检测均采用酶联免疫吸附法（ELISA）,RF的检测采用免疫比浊法。早期RA诊断的金标准采用美国风湿病学会（ACR）1987年修订的RA分类标准。结果在单独检测任何一项指标时,对中国汉族早期RA诊断的敏感性由高到低依次为GPI （82.8%）、RF （81.0%）及抗CCP抗体（76.7%）,特异性由高到低依次为抗CCP抗体（97%）、RF（83%）及GPI （79%）;联合检测抗CCP抗体及RF这两项指标对中国汉族早期RA诊断的敏感性及特异性分别为51.7%及98%;而在联合检测GPI、抗CCP抗体与RF这三项指标时,其对中国汉族早期RA诊断的敏感性及特异性分别为49.1%及100%。和单独检测一项指标相比,联合检测抗CCP抗体及RF这两项指标及联合检测GPI、抗CCP抗体与RF这三项指标对中国汉族早期RA诊断的敏感性均有明显下降（P〈0.05）,但特异性均有显著提高（P〈0.05）。和联合检测抗CCP抗体及RF这两项指标相比,联合检测GPI、抗CCP抗体与RF这三项指标对中国汉族早期RA诊断的敏感性有稍微降低,特异性上升到接近100%,但差异均未达统计学意义（P〉0.05）。结论和仅检测单项指标相比,联合检测GPI、抗CCP抗体与RF这三项指标对中国汉族早期RA诊断的特异性显著提高到接近100%,有助于中国汉族早期RA的确诊。但和目前临床上常用的联合检测抗CCP抗体及RF这两项指标相比,联合检测GPI、抗CCP抗体与RF这三项指标对中国汉族早期RA诊断的敏感性与特异性均无明显优势。

Diagnostic value of combined detection of glucose-6-phosphate isomerase, anti-cyclic citrullinated antibody and rheumatoid factor in Chinese Han patients with early rheumatoid arthritis

Objective To explore the diagnostic value of combined detection of glucose-6-phosphate isomerase, anti-cyclic citrullinated antibody and rheumatoid factor in Chinese Han patients with early rheumatoid arthritis (RA). Methods SSerum samples obtained from 116 Chinese Han early RA patients and 100 healthy controls were assayed for glucose-6-phosphate isomerase, anti-cyclic citrullinated antibody (both by ELISA) and RF (by immunoturbidimetric assay method). All the included patients met the 1987 America College of Rheumatology criteria for early RA. Results he sensitivity and specificity of glucose-6-phosphate isomerase, anti-cyclic citrullinated antibody and rheumatoid factor for the diagnosis of Chinese Han patients with early RA were 82.8%, 76.7%, 81.0% and 79%, 97%, 83% respectively. The sensitivity and specificity of combined detection of anti-cyclic citrullinated antibody and rheumatoid factor for the diagnosis of Chinese Han patients with early RA were 51.7% and 98% respectively. The sensitivity and specificity of combined detection of glucose-6-phosphate isomerase, anti-cyclic citrullinated antibody and rheumatoid factor for the diagnosis of Chinese Han patients with early RA were 49.1% and 100% respectively. The sensitivity of combined detection were decreased (P<0.05), but the sensitivity of combined detection were significantly increased (P<0.05) when compared with detection of single item. The sensitivity of combined detection of glucose-6-phosphate isomerase, anti-cyclic citrullinated antibody and rheumatoid factor was slightly decreased (P>0.05) and the sensitivity reaches nearly 100%, when compared with combined detection of anti-cyclic citrullinated antibody and rheumatoid factor. Conclusion Combined detection of glucose-6-phosphate isomerase, anti-cyclic citrullinated antibody and rheumatoid factor is helpful for diagnosis of early RA in Chinese Han population, but not significantly superior to combined detection of anti-cyclic citrullinated antibody and rheumatoid factor.