联合检测抗CCP、RF、抗RA33在类风湿关节炎的临床应用

目的:探讨抗环瓜氨酸肽抗体（抗CCP）、类风湿因子（RF）、抗RA33抗体联合检测在类风湿关节炎（RA）诊断中意义。方法:选取在我院确诊RA患者266例、非RA风湿病患者228例（结缔组织病、强直性脊柱炎、骨关节炎、系统性红斑狼疮、干燥综合征）、健康体检者215名，检测3组抗CCP、RF、抗RA33数值，统计各指标阳性率，并进行统计学分析比较；通过Spearman 相关分析探讨各指标之间的关系；ROC曲线比较各指标的诊断性能；通过平行试验与系列实验探讨3项指标联合检测RA的诊断效能。结果:RA患者各指标数值均显著高于非RA自身免疫疾病患者与健康对照组（P ＜0.01）；Spearman相关分析显示RA患者抗CCP与抗RA33之间不存在关系，RF与抗CCP、RF与抗RA33之间存在显著相关性（P ＜0.01）；ROC曲线分析显示，抗CCP、RF、抗RA33的AUC值分别为0.942、0.922、0.653；3项指标中，阳性率:RF＞抗CCP＞抗RA33,敏感度:RF＞抗CCP＞抗RA33，特异度:抗RA33＞抗CCP＞RF；平行试验敏感度增高（98.50%），但特异度降低（64.91%），系列实验敏感度为15.41%，特异度为98.68%。结论:抗CCP、RF、抗RA33联合检测可提高诊断RA的敏感度与特异性，适用于RA的早期诊断，临床上值得推广使用。

Joint detection of anti-CCP,RF and anti-RA33 in rheumatoid arthritis clinical application

Objective: To explore the significance and application value of combined detection of anti-cyclic citrullinated peptide antibody (anti-CCP),rheumatoid factor (RF) and anti-RA33 antibody in the diagnosis of rheumatoid arthritis (RA). Methods: 266 patients with RA and 228 patients with non-RA rheumatism (connective tissue disease, ankylosing spondylitis, osteoarthritis, systemic lupus erythematosus, Sjogren’s syndrome) and 215 healthy persons were selected. The anti-CCP, RF and anti-RA33 values of the three groups were detected, and the positive rates of each index were counted and analyzed by Spearman correlation analysis. The diagnostic performance of each index was compared by ROC curve, and the diagnostic efficiency of the three indexes was explored by parallel experiment and series experiment. Results: The values of each index in RA patients were significantly higher than those in non-RA patients with autoimmune diseases and healthy control group (P ＜0.01); Spearman correlation analysis showed that there was no relationship between anti-CCP and anti-RA33 in RA patients, but there was a significant correlation between RF and anti-CCP, RF and anti-RA33 (P ＜0.01); ROC curve analysis showed that the AUC values of anti-CCP, RF and anti-RA33 were 0.942, 0.922 and 0.653, respectively. The positive rate was RF＞anti-CCP＞anti-RA33, sensitivity: RF＞anti-CCP＞anti-RA33, specificity: anti-RA33＞anti-CCP＞RF；the sensitivity of parallel test increased (98.50%), but specificity decreased (64.91%), sensitivity of series test was 15.41%, specificity was 98.68%. Conclusion: The combined detection of anti-CCP, RF, anti-RA33 and anti-RA33 can improve the sensitivity and specificity in the diagnosis of RA, which is suitable for the early diagnosis of RA and is worth popularizing in clinic.