4 种血清标记物在类风湿关节炎诊断中的应用

目的系统评估类风湿因子（RF）、抗环瓜氨酸多肽抗体（抗CCP）、抗角蛋白抗体（AKA）和葡萄糖-6-磷酸异构酶（GPI）联合
检测在类风湿关节炎（RA）诊断中的应用价值和意义。方法分别检测278 例RA病人和510 例对照者血清中的RF、抗CCP、
AKA和GPI等的水平，免疫比浊法检测RF，ELISA法检测抗CCP，间接免疫荧光染色法检测AKA，ELISA法检测GPI，分析4种
血清标记物不同组合在RA诊断中的应用价值和意义。结果在单项、两项及多项检测中，敏感度以RF、RF+抗CCP、RF+抗
CCP+GPI最高；特异度以抗CCP、抗CCP+AKA、RF+抗CCP+AKA+GPI最高；阳性预测值以抗CCP、抗CCP+GPI、RF+抗CCP+
AKA+GPI最高；阴性预测值以GPI、RF+抗CCP、RF+抗CCP+GPI最高；阳性似然比以抗CCP、抗CCP+GPI、RF+抗CCP+AKA+
GPI最高；阴性似然比以GPI、RF+抗CCP、RF+抗CCP+GPI最低。结论在RA诊断中，单项、两项及多项检测以抗CCP、RF+抗
CCP、RF+抗CCP+GPI最理想，抗CCP是检测核心，联合检测可显著提高RA的诊断。

Value of four serum markers in the diagnosis of rheumatoid arthritis

Objective To systematically evaluate the values of 4 serum markers in the diagnosis of rheumatoid arthritis (RA).
Methods Serum samples were obtained from 278 RA patients and 510 control subjects and the levels of rheumatoid factor (RF),
anticyclic citrullinated peptide antibody (CCP), antikeratin antibody (AKA), and glucose-6-phosphate isomerase (GPI) were
detected using immune turbidimetry, ELISA, indirect immunofluorescence, and ELISA, respectively. The values of these 4
serum markers and their combinations in RA diagnosis were systemically assessed. Results In RA diagnosis using one serum
marker, two markers, and three or four markers, RF, RF+CCP, RF+CCP+GPI, respectively, had the highest sensitivity; CCP,
CCP+AKA, and RF +CCP+AKA+ GPI, respectively, had the highest specificity; CCP, CCP+ GPI, and RF +CCP+AKA+ GPI,
respectively, had the highest positive predictive value; GPI, RF+CCP, and RF+CCP+GPI, respectively, had the highest negative
predictive value; CCP, CCP+GPI, and RF+CCP+AKA+GPI, respectively, had the highest positive likely ratio; GPI, RF+CCP, and
RF+CCP+GPI, respectively, had the lowest negative likely ratio. Conclusions CCP, RF+CCP, and RF+CCP+GPI are the most
ideal for RA diagnosis using one, two, and three or more markers, respectively. CCP is the essential marker for RA diagnosis,
and a combined detection of the serum makers can significantly improve the diagnostic accuracy.