类风湿关节炎早期标志物检测的临床评价

Clinical Evaluation of Early Marker in Diagnosing Rheumatoid Arthritis

目的:检测类风湿性关节炎(RA)患者血清中类风湿因子(RF)、抗RA33、抗角蛋白抗体(AKA)、抗核周因子(APF)、抗环瓜氨酸肽抗体(抗CCP)对RA诊断的灵敏度、特异性及其在风湿性疾病中的临床价值。方法:采用免疫散射比浊法测RF,ELISA检测抗CCP、抗RA33,间接免疫荧光法测AKA、APF。共检测了68例RA、98例其它非RA风湿性疾病和40例健康人,并分析5种诊断标志物的临床意义。结果:68例RA患者中RF,抗RA33,AKA,APF,抗CCP的灵敏度分别为76.47%,33.82%,35.29%,39.71%,80.88%;特异性分别为91.84%,92.86%,97.96%,98.98%,98.98%;阳性预测值为86.67%,76.67%,92.31%,96.43%,98.21%;可用度分别为69.04%,39.78%,47.27%,50.85%,80.79%;抗CCP与RF无显著性差异,与抗RA33,AKA,APF有显著性差异。结论:联合检测RF、抗CCP抗体对RA早期诊断具有良好的灵敏度和特异性。

Objective: To evaluate the clinic diagnostic value of the assay of rheumatoid factor (RF), anti-RA33, anti-keratin antibody (AKA), anti-pernuclear factor (APF) and anti-cyclic citrullinated peptide antibody (anti-CCP) in serum of patients with rheumatoid arthritis (RA). Methods: RF was measured by the rate scatting immunity method, anti-CCP and anti-RA33 were measured by ELISA, AKA and APF were measured by immunity fluorescence method in 68 patients with RA and in 98 patients without RA and in 40 normal controls. Results: The sensitivity of RF, anti-RA33, AKA, APF and anti-CCP was 76.47%, 33.82%, 35.29%, 39.71% and 80.88%, respectively; the specificity was 91.84%, 92.86%, 97.96% and 98.98%, 98.98%, respectively;positive predictive value was 86.67, 76.67, 92.31, 96.43 and 98.21 respectively;usable degree was 69.04%, 39.78%, 47.27%, 50.85% and 80.79%, respectively in RA patients; anti-CCP had no statistical difference with RF(P>0.05), but it had a statistical difference with anti-RA33, AKA and APF(P<0.01) in the diagnosis. Conclusion: The combined detection of anti-CCP and RF presents good sensitivity and specificity in diagnosing RA at the early stage.