探讨抗环瓜氨酸肽抗体和类风湿因子对类风湿关节炎的诊断价值

目的探讨抗环瓜氨酸肽抗体（抗CCP抗体）、类风湿因子（RF）联合检测对类风湿关节炎（RA）的诊断价值。方法收集2011年5～9月RA和非RA患者202例,分别采用电化学发光法定量检测抗CCP抗体,免疫比浊法检测RF并进行统计学处理。结果抗CCP抗体诊断试验的灵敏度、特异性和阳性、阴性预测值分别为：78.0%、80.6%、82.5%、75.8%;RF为：89.9%、52.7%、69.0%、81.7%;抗CCP抗体与RF联合检测后作并联及串联统计,上述指标并联分别是：93.6%、51.6%、69.4%、87.3%;串联：74.3%、81.7%、82.7%、73.1%。RA组内灵敏度两两比较结果是：RF及联合抗CCP＋RF并联统计与单项抗CCP比较差异均有统计学意义（P〈0.05）,抗CCP＋RF串联统计则与RF比较差异有统计学意义（P〈0.05）。抗CCP抗体和RF的阳性结果均值中,RA组和非RA组的差值较大。结论联合检测抗CCP抗体和RF比单项检测更能为临床对RA的诊断提供丰富的信息,一定程度上避免了抗CCP抗体灵敏度低而造成的漏诊,以及RF特异性低而造成的误诊,为临床早期正确诊断提供依据。

Evaluate the value of anti -cyclic citrullinated peptide antibody and rheumatoid factor in the diagnosis of rheumatoid ar-thritis

Objective Evaluate the diagnosis value of anti-cyclic citrullinated antibody（anti CCP antibody）combined with rheumatoid factor（RF） for rheumatoid arthritis（RA）.Methods From May 2011 to September 2011,202 patients with rheumatic disease were selected,including RA group,and non-RA group.The quantitative chemiluminescence method to detect anti-CCP antibody,immune turbidimetric assay to test RF,and the results were analyzed statistically.Results The diagnostic test sensitivity of anti-CCP antibody,specificity,positive and the negative predictive value were,78%,80.6%,82.5%,75.8%;RF：89.9%,52.7%,69%,81.7%.To analyze parallel and series test after anti-CCP antibody combined with RF detection,The above indexes were,parallel：93.6%,51.6%,69.4%,87.3%;series：74.3%,81.7%,82.7%,73.1%;The result of comparison in the RA group sensitivity：RF and anti-CCP antibody＋RF series testing compared to individual CCP testing was significantly different（P0.05）,Beside,Anti-CCP antibody＋RF parallel testing and RF testing was significantly different（P0.05）.In the mean of anti-CCP antibody and RF positive results,RA group and RA group was significantly difference.Conclusion Detection of anti CCP antibody Combined with RF could provide clinical diagnosis for RA than individual testing.It could avoid leakage diagnosis caused by the low anti-CCP antibody sensitivity,and misdiagnosis caused by RF low specificity,and provided the basis for clinical early diagnosis.