抗瓜氨酸肽抗体谱在幼年类风湿关节炎诊断中的意义

Diagnostic significance of detection of anti-citrullinated peptide antibodies in juvenile rheumatoid arthritis

目的探讨抗环瓜氨酸肽抗体(抗CCP抗体)、类风湿因子(RF)、抗核周因子(APF)、抗角蛋白抗体(AKA)对幼年类风湿关节炎(JRA)诊断的意义,并与类风湿关节炎(RA)进行比较。方法分别采用酶联免疫吸附试验(ELISA)、胶乳凝集法、间接免疫荧光法检测54例JRA患者、31例非RA对照组、116例成人RA患者血清中的抗CCP抗体、RF、APF、AKA。结果54例JRA患者抗CCP抗体、RF、APF、AKA的敏感性分别为61.1%、57.4%、37.0%、18.5%,特异性分别为96.8%、93.6%、96.8%、100%。抗CCP抗体与RF在JRA的敏感性差异无统计学意义,但明显高于APF、AKA;4种抗体在JRA的特异性比较差异无统计学意义。RA患者中4种抗体敏感性分别为82.3%、78.3%、48.7%、25.4%,特异性分别为95.7%、73.7%、91.6%、94.0%。4种抗体在JRA诊断中的敏感性均明显低于RA组,RF在JRA患者中特异性明显高于RA患者,而其他3种抗体的特异性在两组患者比较差异无统计学意义。结论虽然抗CCP抗体谱在JRA诊断中的敏感性不及RA组,但对JRA的诊断仍具有较好的敏感性和特异性,可用于JRA的诊断。

Objective To assess the diagnostic value of anti-cyclic citrullinated peptide antibody （anti-CCP）, rheumatoid factor, anti-perinuclearfactor （APF） and anti-keratin antibody （AKA） for juvenile rheumatoid arthritis （JR.A） and compare it with rheumatoid arthritis （RA）. Methods Anti-CCP was determined by ELISA in 54 serum samples of JRA patients, 31 from patients with other rheumatic diseases and 116 RA patients. RF was determined in the same samples by latex agglutination test. APF and AKA were determined by indirect immunofluorescent assay. Results The sensitivity of anti-CCP, RF, APF and AKA was 61.1%, 57.4%, 37.0% and 18.5% and their specificity was 96.8%, 93.6%, 96.8% and 100%, respectively for the diagnosis of JRA. The sensitivity of anti-CCP resembleed that of RF, Anti-CCP was more sensitivity than APF and AKA in JRA. The sensitivity of anti-CCP, RF, APF and AKA was 82.3%, 78.3%, 48.7% and 25.4% and their specificity was 95.7%, 73.7%, 91.6%, 94.0% respectively, for the diagnosis of RA. Anti-CCP, RF, APF and AKA were less sensitive in JRA than in RA. There was no statistical significance in specificity of these anti- bodies for the diagnosis of JRA and RA. Conclusion The detection of anti-CCP, RF, APF and AKA are useful for the diagnosis of JRA, but are less sensitive than in adults RA.