抗核周因子、抗角蛋白抗体与类风湿因子联合检测在类风湿关节炎中的意义

Implications of combination detection with anti-perinuclear factor,anti-keratin antibody and rheumatoid factor in rheumatoid arthritis

目的探讨抗核周因子(APF)、抗角蛋白抗体(AKA)及类风湿因子(RF)联合检测对类风湿关节炎(RA)诊断的特异性和敏感性,三种抗体之间的相关性和与RA临床表现的相关性。方法为45例RA患者,46例非RA的风湿性疾病患者及20例健康人,分别以人颊黏膜和大鼠食管冰冻切片为底物,用间接免疫荧光法检测APF、AKA及RF。结果APF、AKA和RF在RA诊断的敏感性和特异性分别是57.78%(26/45)和97.01%(65/67),68.89%(31/45)和94.03%(63/67)及86.67%(39/45)和89.55%(60/67);三种抗体任两种以上抗体阳性时,在RA的特异性和敏感性为98.51%(66/67)和75.56%(31/45);三种抗体之间比较无相关性;据阳性抗体数分组,组间在X线分期,关节外表现、CRP水平的差异上有显著性(P<0.05)。结论三种抗体联合检测可提高对RA诊断特异性及诊断率;两种以上抗体阳性RA患者,骨破坏更严重。三种抗体均阳性较抗体均阴性RA者,关节外表现更多,炎症反应更重。

[Objective] To study the sensitivity and specificity of the detection by anti-perinuclear factor （APF）, anti-keratin antibody （AKA） and rheumatoid factor （RF）, the relationship of the three antibodies and the relationship between the antibodies and the clinical manifestations. [Methods] 45 RA patients, 46 patients with other rheumatic diseases and 20 volunteers were enrolled in the study. The frozen sections from human gena mucous and rat esophagus were respectively used as the substrates. The APF, AKA and RF were determined by indirect immunofluorescence. [Results] The sensitivity and specificity of APF, AKA and RF were 57.78% （26/45） and 97.01% （65/67）, 68.89% （31/45） and 94.03% （63/67）, 86.67% （39/45） and 89.55% （60/67）. The specificity and sensitivity were 98.51% （66/67） and 75.56% （31/45） when any two or all these three antibodies were positive. Among the three antibodies was not related to each other. The X-ray staging, extra-articular manifestations and level of C-reactive protein in the patients with positive antibodies were significantly different from those in the patients with negative, antibodies （P 〈0.05）. [Conclusions] The combination detection of three antibodies can improve the specificity for the diagnosis and is helpful to the early diagnosis of RA. The bone erosion is more severe in the patients with detectible two positive antibodies. The extra-articular manifestations present more frequently in the patients with all three positive antibodies.