类风湿关节炎五项诊断指标的应用价值评价

Assessment on the application value of five auto-antibodies in rheumatoid arthritis diagnosis

目的评价分析抗瓜氨酸化波形蛋白（MCV）抗体、抗葡萄糖-6-磷酸异构酶（GPI）抗体等5项指标在类风湿关节炎（RA）患者血清中的表达与疾病的相关性及应用价值。方法收集150例RA、32例SLE、30例强直性脊柱炎（OA）、20例骨关节炎（AS）、20例干燥综合征（SS）、20例结缔组织病（CTD）患者和40名健康人血清标本。采用ELISA分析血清中抗MCV、抗GPI和抗环瓜氨酸肽（CCP）抗体水平，采用间接免疫荧光法检测抗角蛋白（AKA）抗体，采用速率散射比浊法检测类风湿因子（RF）水平。分别计算和比较单项标志物诊断RA的效能；选择高敏感度与高特异度抗体联合检测，并计算其与RF联合诊断RA的效能。结果5种抗体在RA患者组中的阳性率显著高于疾病对照组和健康对照组（χ^2分别为88．5、76．0、279．2、88．2、94．8，P均〈0．05）。除AKA抗体阳性率较低（37．3％）外，其余抗体在RA中的阳性率差异无统计学意义（χ^2分别为21．9、9．4、20．2、43．2、41．6，P均〉0．05）。单项抗体检测中，抗MCV和抗GPI抗体的敏感度最高，分别为78．0％和83．3％，抗CCP抗体的特异度最高，为97．1％，具有高特异度（96．1％）的AKA抗体敏感度最低，仅为49．4％。抗MCV／抗CCP抗体联合检测的敏感度和特异度最高，分别为92．7％和96．9％。RF／抗GPI／抗CCP抗体联合检测的敏感度和特异度为90．7％和96．9％，RF/抗MCV/抗CCP抗体联合检测的敏感度和特异度为94．0％和96．9％。结论抗MCV和抗GPI抗体诊断RA的敏感度最高；抗CCP抗体的特异度最高，AKA抗体虽然具有较高的特异度，但敏感度最低，联合检测可弥补单项抗体检测造成的RA漏诊，RF/抗GPI／抗CCP抗体和RF／抗MCV／抗CCP抗体的组合模式可同时提高诊断RA的敏感度和特异度。

Objective To investigate the level of five auto-antibodies including MCV and GPI in the serum of RA patients and assess the application value of five auto-antibodies in RA diagnosis. Methods The five auto-antibodies were detected by ELISA in serum samples of 150 patients with RA and 40 healthy controls, 32 patients of SLE, 30 patients of OA, 20 patients of AS, 20 patients of SS, 20 patients of CTD. Results The positive rates of these five auto-antibodies in RA patients were significantly higher than in other groups（χ^2 =88.5,76.0,279.2,88.2,94.8,P 〈0.05）. Except anti-AKA , there was no the differences in the level of other antibodies among groups （χ^2 = 21.9,9.4,20. 2,43.2,41.6, P 〉 0. 05 ）. Anti-MCV and anti-GPI has the highest sensitivity （78.0% and 83.3% ） , while anti-CCP has the highest specificity （97.1%） and anti-AKA has good specificity （96. 1% ） and lowest sensitivity （49.4%）. When two antibodies were detected together, the sensitivity and specificity of MCV/CCP were highest （92. 7% and 96. 9% ）. When RF/GPI/CCP were detected together, the sensitivity and specificity were 90. 7% and 96. 9%, respectively. When RF/MCV/CCP were detected together, the sensitivity and specificity were 94.0% and 96. 9%. Conclusions Anti-MCV and anti-GPI has the highest sensitivity in laboratory diagnosis of RA, while anti-CCP has the highest specificity and anti-AKA have good specificity and lowest sensitivity. The combination detection can decrease the amount of missed diagnosis caused by single test. The combination detection of RF/GPI/CCP and RF/MCV/CCP will improve sensitivity and specificity for diagnosis to the RA patients.