抗角蛋白抗体定性检测对类风湿关节炎诊断及病情评估的价值

目的抗角蛋白抗体(AKA)定性检测对类风湿关节炎(RA)的诊断及病情评估。方法选择2004年7月~2005年1月本院风湿免疫科门诊及住院的RA患者53例(RA组),选择同期本院内科收治经AKA检测证实非RA的住院患者62例(非RA组)作对照,采用间接免疫荧光法(IIF)检测血清AKA,速率散射比浊法检测类风湿因子(RF);比较两组病人AKA、RF检测的阳性率及对诊断的敏感度和特异度;比较RA组AKA阳性、阴性者的一般项目、临床检查、实验室检测指标和疾病活动性评分(DAS28)。结果(1)RA组AKA、RF的阳性率均明显高于非RA组(均P<0.05);AKA敏感度62.3%,特异度高达96.8%;二者联合检测,敏感度47.2%,特异度达100%;AKA与RF的检测无相关性(P>0.05)。(2)RA组AKA阳性、阴性者各指标除手关节畸形、压痛关节数、肿胀关节数、关节侵蚀程度差异有统计学意义(均P<0.05)外,余均P>0.05;较阴性者明显增高(P<0.05)。结论(1)AKA是一种对RA有较高特异度的血清学检测指标,AKA的检测与RF无相关性,AKA和RF的联合检测可提高对RA诊断的特异度。(2)AKA阳性的RA患者具有更强的疾病活动性。

The Value of Determination of AKA in the Diagnosis and Disease Assessment of RA

Objective To explore the significance of determination of anti-keratin antibody(AKA) in rheumatoid arthritis(RA).Methods AKA was detected by IIF (indirect immunofluorescence) and RF were detected by rate nephelometry in 53 RA patients and 62 controls with other internal diseases.The positive rate of AKA and RF were evaluated in two groups and the diagnostic sensitivity and specificity of AKA were compared with RF;General items,clinical manifestation,lab findings and DAS28 were compared in AKA positive RA patients with AKA negative ones.Results(1)The positive rate of AKA and RF in RA Patients were significantly higher than that in controls;AKA showed a diagnostic sensitivity of 62.3% and a high specificity of 96.8%;Combined detection of AKA and RF showed a high specificity of 100% and a sensitivity of 47.2%.AKA had no relevance with RF.(2)Compared with AKA negative ones,AKA positive RA patients developed more severe disease activity based on hands deformity,TJC,SJC,degree of joint erosion and DAS28. Conclusions(1)Compared with RF,AKA shows higher disease specificity in RA patients.AKA has no relevance with RF.Combined detection of AKA and RF is helpful in the diagnosis of RA.(2)AKA positive patients may develop more severe disease activity and joint erosion degree.