4种抗体联合检测在RA早期诊断中的意义

目的:同时检测抗CCP抗体、APF、AKA、抗2型胶原抗体在类风湿关节炎(RA)中的敏感性及特异性,探讨四者联合检测在RA早期诊断中的意义。方法:采用ELISA检测抗CCP抗体,改良的间接ELISA法检测抗2型胶原抗体,间接免疫荧光法检测APF和AKA。共检测165例RA患者、176例非RA患者和136健康者,比较四者之间的敏感性、特异性及四者联合检测的结果。结果:4种抗体对RA的敏感性由低到高顺序为:抗2型胶原蛋白抗体(26.1%)、APF(49.1%)、AKA(50.9%)和CCP(76.9%)。对RA的特异性由高到低依次为CCP(98.1%)、AKA(97.8%)、APF(91.0%)和抗2型胶原蛋白抗体(86.2%)。CCP和AKA联合对RA的敏感性为47.3%,特异性为98.4%;CCP、AKA和APF联合对RA的敏感性为40.6%,特异性为99.0%;CCP、AKA和抗2型胶原蛋白抗体联合对RA的敏感性为26.7%,特异性为99.0%;4种抗体联合对RA的敏感性为15.8%,特异性为99.7%。结论:抗CCP抗体、APF、AKA、抗2型胶原抗体4种自身抗体对RA具有高度特异性,且在RA早期即可出现。4种抗体联合检测有助于提高RA的早期诊断率。

Value of early diagnosis of rheumatoid arthritis by combining determination of four autoantibodies

Objective: To investigate the specificity and sensitivity of anti-perinuclear factor(APF),anti-keratin antibody(AKA),Anti-cyclic citrullinated peptide(CCP)antibody;anti-type 2 collagen antibody by simultaneous determination and combining determination respectively for the early diagnosis of rheumatoid arthritis(RA).Methods: One hundred and sixty-five patients with RA,176 patients with non-RA and 136 healthy volunteers were studied.APF and AKA were determined by indirect immunofluorescence,CCP was determined by ELISA,anti-type2 collagen antibody was determined by modified indirect ELISA.Their specificity,sensitivity and result of combining determination were compared.Results: The diagnostic sensitivity of anti-type2 collagen antibody,APF,AKA and CCP were 26.2%,49.1%,50.5% and 76.9%,respectively.The specificity of CCP,AKA,APF,and anti-type2 collagen antibody were 98.1%,97.8%,91.0% and 86.2%,respectively.The sensitivity and specificity of combining determination of CCP and AKA were 47.3% and 98.4% respectively.The sensitivity and specificity of combining determination of CCP,AKA and APF were 40.6% and 99.0%respectively.The sensitivity and specificity of combining determination of CCP,AKA and anti-type2 collagen antibody were 26.7% and 99.0% respectively.The sensitivity and specificity of combining determination of CCP,AKA,APF and anti-type2 collagen antibody were 15.8% and 99.7% respectively.Conclusin: CCP,AKA,APF and anti-type2 collagen antibody have high specificity for the diagnosis of RA;they present early in patients with RA.Combining determination of CCP,AKA,APF and anti-type2 collagen antibody can improve early diagnosis of RA.