血清抗角蛋白抗体抗环瓜氨酸肽抗体和类风湿因子在类风湿关节炎中的意义

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

目的评价抗角蛋白抗体（AKA）、抗环瓜氨酸肽（CCP）抗体和类风湿因子（RE）在类风湿关节炎（RA）中的意义。方法收集82例RA患者及56例非RA患者，测定其抗CCP抗体、AKA和RF水平，评价对RA诊断的敏感性、特异性，比较RA患者中抗CCP抗体、AKA阳性组和阴性组的压痛关节数、肿胀关节数、红细胞沉降率（ESR）、C反应蛋白（CRP）、疾病活动指数（DAS）、Ritchie’s指数（RAI）。结果单独检测AKA、抗CCP抗体、RF及联合检测的曲线下面积都较高（P〈0．05）。抗CCP抗体、AKA的特异度分别为92．9％、91．1％，联合检测AKA、抗CCP抗体和RF有任何一种及以上阳性的灵敏度最高，为95．1％。抗CCP抗体阳性组与阴性组的关节肿胀数、关节压痛数、ESR、CRP、DAS、RAI差异有统计学意义（P〈0．05）；AKA阳性组与阴性组的关节肿胀数、ESR、DSA差异均有统计学意义（P〈0．05）。结论联合检测抗CCP抗体、RF、AKA对诊断RA有意义，抗CCP抗体、AKA可能与RA的活动度相关。

Objective To evaluate the role of rheumatoid factor （RF）, anti-cyclic citrullinated peptide antibody （ACCP） and anti-keratin antibody （AKA） in patients with rheumatoid arthritis （RA）. Methods Serum levels of RF, ACCP and AKA were examined in 82 RA and 56 non-RA patients and their sensitivity and specificity for the diagnosis of RA were exmined. Statistical analysis was performed to test the association between ACCP/AKA and number of tender joints and swollen joints, ESR, CRP, disease activity score （DAS） or Ritchie＇s articular index （RAI）. Results ROC curve was performed for each single autoantibody and various combinations of any two of the above antibodies. The area under the ROC curve was over 0.5 （P〈0.05）. The specificity of ACCP and AKA was 91.1% and 92.9% respectively. RF, ACCP and AKA were all sensitive markers for the diagnosis of RA and the sensitivity could be as high as 95.1% when one of these markers was positive. There were statistical differences in the number of swollen joints, ESR and DAS between ACCP positive group and ACCP negative group （P〈0.05） and statistical significant difference was observed in tender joint count, swollen joint count, ESR and DAS between AKA positive and negative groups （P〈0.05）. Conclusion Combined test of ACCP, RF and AKA is useful in routine RA diagnosis. ACCP and AKA may be clinical markers for predicting disease activity and prognosis.