抗环瓜氨酸肽抗体在类风湿性关节炎诊断中的应用评价

Evaluation of Anti-cyclic Citrullinated Peptide Antibody in Diagnosing Rheumatoid Arthritis

目的评价抗环瓜氨酸肽抗体(抗CCP抗体)在类风湿性关节炎(RA)诊断中的意义。方法选取类风湿性关节炎106例,其他疾病对照组223例(其中非RA的风湿性疾病132例,非风湿性疾病91例),正常对照组50例。对上述379份人群血清进行抗CCP抗体及IgM-RF检测,分析抗CCP抗体、IgM-RF及两者联合检测的敏感性、特异性、阳性预告值和阴性预告值。结果抗CCP抗体及IgM-RF对诊断RA的敏感性、特异性、阳性预告值和阴性预告值分别为:抗CCP抗体(66.04%,98.90%,95.89%,88.24%),IgM-RF(74.53%,79.49%,58.52%,88.93%)。抗CCP抗体与IgM-RF联合检测敏感性和特异性分别为58.49%、99.27%,阳性预告值和阴性预告值分别为96.88%、86.03%。提示抗CCP抗体特异性、阳性预告值明显高于IgM-RF,IgM-RF较抗CCP抗体敏感性、阴性预告值高,两者联合检测可提高诊断的特异性和阳性预告值,但不能提高敏感性和阴性预告值。结论抗CCP抗体对RA诊断特异性高,IgM-RF特异性相对较低,两者联合检测可提高诊断的特异性及阳性预告值,但不能提高敏感性和阴性预告值。

Objective To evaluate the diagnostic value of anti - cyclic eitrullinated peptide anti - body （ anti - CCP ） in rheumatoid arthritis （RA）patients, Methods： Anti -CCP antibodies and IgM -RF were detected in 379 serum samples ： 106 from patients with established RA and 273 from non - RA controls, the results were compared to anti - CCP for sensitivity,specificity,positive predictive value （PPV） and negative predictive value（NPV）. Results the sensitiviety ,specificity ,PPV and NPV of anti -CCP and IgM -RF were 66.04% ,98.90%,95.89%,88.24%,vs,74.53%,79.49%,58.52%,88.93% respectively, The combinative detection of anti - CCP and IgM - RF were 58.49% ,99.27% ,96.88% ,86.03%. It suggested that the specificity？ PPV of anti - CCP were higher than IgM -RF ,but the sensitivity,NPV of IgM -RF was higher than that of anti -CCP . The combinative detection of anti -CCP and IgM - RF can increase the specificity and PPV ,but not in sensitivity,NPV. Conclusion Anti - CCP has higher specificity （98.90%） for RA than IgM - RF（78.49% ）. The combination between anti - cop antibody and IgM - RF can increase the specificity and PPV, but not in sensitivity,NPV. Anti - CCP is useful tor the diagnosis of RA, especially combined with IgM - RF.