四种抗体联合检测对早期类风湿性关节炎的诊断意义

目的：探讨抗环瓜氨酸肽抗体、抗RA54抗体、抗Sa抗体和类风湿因子联合检测对早期类风湿性关节炎的诊断意义。方法：对116例类风湿性关节炎患者，分别用ELISA法检测抗环瓜氨酸肽抗体，免疫印迹法检测抗RA54抗体、抗Sa抗体，免疫比浊法检测类风湿因子。结果：(1)抗环瓜氨酸肽、抗RA54、抗Sa抗体和类风湿因子对早期类风湿性关节炎诊断的特异性和敏感性分别是93．9％和41．4％，90．9％和30．2％，92．4％和36．2％，77．3％和49．1％。类风湿因子滴度至1：128时，与上述3种抗体在特异性上的差异无显著意义。在59例类风湿因子阴性类风湿性关节炎患者中，16例(27．1％)抗环瓜氨酸肽抗体阳性，14例(23．7％)抗RA54抗体阳性，19例(32．2％)抗Sa抗体阳性。(2)4种抗体中任何两种抗体同时阳性的诊断特异性和敏感性分别是98．5％和46．6％。而当三种或三种以上抗体阳性时，特异性可迭100％。结论：四种抗体联合检测可明显地提高对早期类风湿性关节炎的诊断特异性，有助于早期类风湿性关节炎的诊断和治疗。

Detection and significance of the anti-CCP antibody, anti-RA54, anti-Sa antibody and rheumatoid factor in patients with rheumatoid arthritis

Objective To assess and detect the diagnostic significance of anti-CCP, anti-RA54, anti-Sa antibody and rheumatoid factor in rheumatoid arthritis patients. Methods Anti-CCP antibody were deteceted with ELISA, anti-RA54 antibody and anti-Sa antibody were examined with western blotting, and rheumatoid factor was deteceted with immunoturbidimetric assay in 116 patients with rheumatoid arthritis. Results (1)The specificities and sensitivities of anti-CCP, anti-RA54, anti-Sa antibody and rheumatoid factor were 93. 9% and 41. 4%, 90. 9% and 30. 2%, 92. 4% and 36.2%, 77. 3% and 49. 1%. There were no statistic differences in the specificity between the three antibody groups and rheumatoid factor until 1 : 128 was taken as positive titer. Among 59 patients with RF negative rheumatoid arthritis, 16(27. 1%) were positive for anti-CCP, 14(23. 7%) positive for anti RA54 and 19(32. 2%) positive for anti-Sa antibody. (2) The specificity and sensitivity were 98. 5% and 46. 6% respectively when two of the four antibodies turned out to be both positive. If three or more kinds were detected simultaneously, the specificity was 100%. Conclusion Detection of anti CCP, anti-RA54, anti-Sa antibody and rheumatoid factor can greatly improve the specificity of the diagnosis of early rheumatoid arthritis.