RF、CCP和AKA联合检测在类风湿关节炎诊断中的评价

Evaluation of rheumatoid factor,anti-cyclic citrullinated peptide antibody and anti-keratin antibody in patients with rheumatoid arthritis.

目的联合检测类风湿关节炎(RA)患者血清中的类风湿因子(RF)、抗环瓜氨酸肽抗体(CCP)和抗角蛋白抗体(AKA),探索其在RA诊断中的意义。方法对69例RA患者、163例非RF的风湿免疫病患者血清同时进行测定了RF(速率散射比浊法)、CCP(EL ISA法)和AKA(间接免疫荧光法),并对三者之间检测的一致性以及与其他临床指标的关系进行了分析。结果RF、CCP和AKA对RA的敏感性分别为79.7%(55/69)、68.1%(47/69)和29.0%(20/69),特异性分别为75.5%、98.2%和100%。CCP的检测阳性率高于AKA(P<0.01),与RF无差异(P=0.057),且与二者的检测具有一定的吻合度(k分别为0.271和0.483,P<0.01);CCP阳性组患者病程和RF表达量高于阴性组患者(P<0.05),但患者年龄、ESR和CRP等无差异(P>0.05)。结论CCP抗体对RA具有较高的敏感性和高度的特异性,且对RA的病情如预后等可能有一定意义,值得临床推广应用。

Objective To examine rheumatoid factor （RF）, anti -cyclic citrullinated peptide antibody （CCP） and anti -keratin antibody （AKA） and to evaluate their roles in patients with rheumatoid arthritis（RA）. Methods Serum level of RF, CCP and AKA were examined simultaneously by rate nephelometry method, ELISA and indirect inmmnofluorescence （IIF） respectively in 69 RA and 163 non -RA patients. The data were then analyzed accordingly. Results In RA patients, the sensitivity of RF, anti - CCP, and AKA were 79.7 % （ 55/69 ） ,68, 1% （47/69） and 29% （20/69）while the specificity was 75.5 % ,98.2 % and 100% respectively. As for sensitivity, there was a significant difference between the two methods of anti - CCP and AKA assay. However, no difference was found between anti - CCP and RF assay. Measure of agreement of anti - CCP is related to that of RF and AKA（ k = 0.483 和 0.271, p 〈0. 01 ）. The history was longer and RF titer was higher in the CCP positive RA patients than in the CCP negative RA patients. Conclusion Anti - CCP is quite sensitive and specific in the diagnosis of RA and it may be a usful factor for the prognosis of RA.