抗环瓜氨酸肽抗体在类风湿关节炎诊断中的临床应用探讨

目的 探讨抗环瓜氨酸肽（CCP）抗体在类风湿关节炎（RA）诊断中的临床意义.方法 用微粒子化学发光免疫分析（CLIA）法检测抗CCP抗体,速率散射比浊法测定类风湿因子（RF）.选取2010年2月～2013年12月本院门诊或住院的RA患者104例（RA组）,非RA自身免疫性疾病患者76例（非RA组）及同期来本院的健康体检者40例（对照组）.检测各组的抗CCP抗体、RF水平并作比较.结果 RA组的抗CCP抗体阳性率、RF阳性率均显著高于非RA组、对照组（P＜0.05）;RA组的抗CCP抗体阳性率高于RF阳性率,但差异无统计学意义（P＞0.05）.抗CCP抗体、RF对RA诊断的灵敏度差异无统计学意义（P＞0.05）,抗CCP抗体对RA诊断的特异度高于RF（P＜0.05）;两者联合检测的特异度为97.4％,但灵敏度较单独RF有所下降,差异无统计学意义（P＞0.05）.抗CCP抗体含量与RF浓度呈正相关（r=-0.413）.结论 抗CCP抗体检测可作为诊断RA的特异性实验室指标;抗CCP抗体、RF联合检测可以提高临床诊断RA的灵敏度、特异度.

Clinical application discussion of anti-cyclic citrullinated peptide antibody on the diagnosis of rheumatoid arthritis

Objective To discuss the clinical significance of anti-cyclic citrullinated peptide （CCP） antibody on the di- agnosis of rheumatoid arthritis （RA）. Methods Anti-CCP antibody was tested by chemilumineseent immunoassay （CLIA） and rheumatoid factors （RF） were determined by rate nephelometry.From February 2010 to December 2013,104 patients with RA treated in outpatient and hospital of our hospital were selected as the RA group,76 patients with autoimmune diseases excluding RA were chosen as the non-RA group,and 40 healthy people for physical examinations in the same period were classified into the control group.The level of anti-CCP antibody and RF in each group were determined and the results were analyzed statistically. Results In the RA group,the positive rate of anti-CCP antibody and RF was obviously higher than that in the non-RA group and the control group respectively （P〈0.05）,and the positive rate of anti-CCP antibody was higher in comparison with positive rate of RF,but didn＇t display statistical difference （P〉0.05）. There was no statistical difference of sensitivity between anti-CCP antibody and RF for diagnosing RA （P〉0.05）,the specificity of anti-CCP antibody was higher than RF anti-CCP antibody （P〈0.05）.The specificity could reach over 97.0% on joint detection of the two indexes,but the sensitivity decreased in comparison with detection on by RF without statistical difference （P〉0.05）.The concentration of anti-CCP antibody was positively correlated with RF （r=0.413）. Conclusion Anti-CCP antibody detection can be considered as a specific laboratory index for diagnosing RA.Joint de- tection of anti-CCP antibody and RF can improve the sensitivity and specificity on the diagnosis of RA in clinic.