抗环瓜氨酸肽抗体与类风湿因子IgM联合检测在类风湿关节炎早期诊断中的应用

Application of combined detection of anti-cyclic citrullinated peptide antibody and rheumatoid factor IgM-RF in rheumatoid arthritis early diagnosis

目的：探讨抗环瓜氨酸肽抗体（anti-CCP）、类风湿因子IgM（IgM-RF）联合检测在类风湿关节炎（RA）早期诊断中的价值。方法：用ELISA法对84例RA、96例非RA和26例健康献血者中anti-CCP抗体及IgM-RF进行检测；分析anti-CCP抗体、IgM-RF及两者联合检测的敏感度、特异度、阳性似然比、阴性似然比。结果：RA患者anti-CCP抗体的含量约为15．73±3．35Ru／ml；IgM-RF约为79．93±33．83Ru／mL，均显著高于非RA组和健康对照组（P〈0．01）。anti-CCP抗体及IgM-RF对诊断RA的敏感度、特异度、阳性似然比、阴性似然比分别为：anti-CCP抗体（67．9％、94．8％、13．02、0．34），IgM-RF（71．4％、79．2％、3．43、0．36）。anti-CCP抗体与IgM-RF联合检测敏感度和特异度分别为65．5％、96．9％，阳性似然比、阴性似然比分别为21．13、0．36。提示anti-CCP抗体的特异度、阳性似然比明显高于IgM-RF，IgM-RF较anti-CCP抗体有较高的敏感度，两者联合检测可提高诊断的特异度和阳性似然比，但不能提高敏感度。结论：anti-CCP抗体和IgM-RF联合检测可提高诊断的特异度和阳性似然比，对RA的早期诊断有较好的临床价值。

Objective To evaluate the clinical value of combined detection of anti-cyclic citrullinated peptide antibody and rheumatoid factor IgM-RF in rheumatoid arthritis （RA） early diagnosis. Methods 84 patients with established RA, 96 patients without RA and 26 healthy blood donors were enrolled in the investigation. Serum anti-CCP antibody and IgM-RF were detected by applying enzyme- linked immunosorbent assay （ELISA）, and the results of anti-CCP antibody and IgM-RF were compared for sensitivity, specificity, positive likelihood radio （＋LR） and negative likelihood radio （-LR）. Meanwhile, combined detection results of anti-CCP antibody and IgM-RF was also analyzed. Results The serum level of anti-CCP antibody and IgM-RF in RA group was （15. 73 ± 3. 35） RU/ml and （79. 934±33.83） RU/ml, were obviously higher than that in non-RA group and healthy control group respectively. The sensitivity, specificity, ＋LR and -LR of anti-CCP antibody in diagnosing RA was 67.9%, 94.8%, 13.02 and 0.34 respectively, and the corresponding item of IgM-RF was 71.4%, 79.2M, 3. 43 and 0. 36 respectively, the combined detection of anti-CCP antibody and IgM-RF 65.5M ,96.9%, 21.13 and 0. 36 in sequence. It suggested that the specificity and q-LR of anti-CCP antibody were obviously higher than those of IgM-RF; but the sensitivity of IgM-RF was higher than that of anti-CCP antibody. The combined detection of anti-CCP antibody and IgM-RF might increase the specificity and ＋LR, but not in the sensitivity. Conclusion Anti-CCP antibody has a higher speci- ficity （94.8M） than IgM-RF （79. 2%） for RA. The combined detection of anti-CCP antibody and IgM-RF may further increase the specificity and ＋LR, and it has a higher clinical value in RA early diagnosis.