瓜氨酸相关自身抗体在类风湿关节炎早期诊断的应用

目的探讨瓜氨酸相关自身抗体及类风湿因子(RF)在类风湿关节炎(RA)疾病活动中的意义及应用价值。方法采用间接免疫荧光法检测抗核周因子抗体(APF)和抗角蛋白抗体(AKA),ELISA法检测抗环瓜氨酸肽抗体(抗CCP),以及免疫比浊法检测类风湿因子。共检测血清标本321例,其中RA患者156及非RA患者为165例,120例健康对照血清。结果APF、AKA、抗CCP、RF的灵敏度分别为78.21%、51.92%、73.08%和80.76%,特异性分别为98.95%、97.90%、98.25%和82.46%。AKA的灵敏度最低,与APF、抗CCP和RF比较差异有显著性(P<0.01),APF、抗CCP和RF的灵敏度差异无显著性。RF的特异性最低,与APF、AKA、抗CCP比较差异有显著性(P<0.01)。RF阴性的RA患者,APF、AKA、抗CCP可为阳性。结论APF和抗CCP诊断RA灵敏度好,特异性高,有较好的临床应用价值,联合检测APF、AKA、抗CCP和RF可以提高RA的诊断灵敏度,有利于RA的早期诊断。

Application of anti-citrullinated peptide autoantibodies in early diagnosis for rheumatoid arthritis

Objective To study the significance and value of anti-citrullinated peptide autoantibodies and rheumatoid factor（RF） in the diagnosis for rheumatoid arthritis.Methods 321 serum samples（156 RA,165 non-RA patients and 120 normal controls） were tested.The level of APF and AKA were tested simultaneously by indirect immunofluorescence,anti-CCP were tested by ELISA,RF were tested by immunoturbidimetry.Results The sensitivity of APF,AKA,anti-CCP and RF in the diagnosis for RA was 78.21%,51.92%,73.08% and 80.76%,while the specificity was 98.95%,97.90%,98.25% and 82.46%,respectively.The sensitivity of AKA was the lowest in these test index and there was significantly different among APF,anti-CCP and RF（P〈0.01）.No significant difference were found in the sensitivity of APF,anti-CCP and RF.The specificity of RF was the lowest one and was significantly difference among APF,AKA,anti-CCP（P〈0.01）.Patients with RF who were negative in RA can be positive in APF,AKA,anti-CCP.Conclusion The APF and anti-CCP presents a good sensitivity and specificity in the diagnosis of RA.To exam APF,AKA,anti-CCP and RF simultaneously can enhance the sensitivity and was useful for early diagnosis for rheumatoid arthritis.