类风湿因子及相关自身抗体对类风湿关节炎的诊断价值

目的探讨类风湿因子（RF）、抗环瓜氨酸肽抗体（抗CCP）及抗角蛋白抗体（AKA）联合检测对类风湿关节炎（RA）的临床诊断价值。方法对80例RA和65例非RA的其他自身免疫病患者检测RF、RF-IgM、抗CCP及AKA 4种指标。结果自身免疫性疾病女性发病较高,以RA组为甚;RA组的RF、RF-IgM、抗CCP及AKA高于其他自身免疫性疾病组;单指标检测RA诊断的敏感性为RF〉RF-IgM〉AKA〉抗CCP,特异性为RF-IgM〉抗CCP〉RF〉AKA。阳性预测值为抗CCP〉RF〉RF-IgM、AKA,阴性预测值为RF〉RF-IgM〉AKA〉抗CCP;以并联或串联方式联合检测均以RF、RF-IgM及抗CCP三联及RF、RF-IgM、抗CCP及AKA四联检测为佳,并联检测的敏感性分别为93%及97%,串联检测的特异性分别为98%及99%。结论 RF、RF-IgM、抗CCP及AKA 4种指标联合检测可提高对RA诊断的敏感性和特异性,对RA的早期诊断有较高价值。

Value of Rheumatoid Factor and Associated Autoantibodies in the Diagnosis for Rheumatoid Arthritis

Objective To evaluate the clinical significance of combined detection of anti-cyclic citrullinated peptide antibody（anti-CCP）,anti-keratin antibody（AKA） and rheumatoid factor（RF） in the diagnosis of rheumatoid arthritis（RA）.Method RF,RF-IgM,anti-CCP antibodies and AKA were detected in 80 RA patients and 65 non-RA patients of autoimmune diseases.Results A higher incidence of autoimmune disease was in women,and the RA group was the highest.RF,RF-IgM,anti-CCP and AKA of RA group were significantly higher than other autoimmune disease.The sensitivity of these indicators for RA diagnosis was RFRF-IgMAKAanti-CCP,and the specificity was RF-IgManti-CCP RFAKA when detected separately.Positive predictive value was anti-CCP RF RF-IgM,AKA.Negative predictive value was RF RF-IgM AKA anti-CCP.The three combined detection of RF,RF-IgM and anti-CCP and the four combined detection of RF,RF-IgM,anti-CCP,and AKA were better in parallel or in series.The sensitivity of 3 and 4 combined detection in parallel was 93% and 97%,respectively,while the specificity of serial detection was 98% and 99%,respectively.Conclusion Combined detection of the four indicators（RF,RF-IgM,anti-CCP,AKA） can improve the diagnostic sensitivity and specificity of RA,and have higher value in the early diagnosis.