以抗环瓜氨酸肽抗体改进对1987年美国风湿病学会关于类风湿关节炎分类标准的探讨

Evaluation of ACR 1987 criteria and the role of anti-cyclic citrullinated peptide antibodies for the diagnosis of rheumatoid arthritis

目的改进1987年美国风湿病学会（ACR）修订的类风湿关节炎（RA）分类标准，增加抗环瓜氨酸肽（CCP）抗体和（或）保留类风湿结节或放射学改变等，探讨不同条件下的标准（分别称为RA-6、RA-7以及RA-8）对RA诊断的敏感性和特异性。方法选取2006-2008年于北京大学人民医院风湿免疫科就诊的具有关节症状的患者604例，其中，RA患者312例，其他风湿病患者292例。在总结患者临床和实验室资料的基础上，对1987年ACR分类标准以及RA-6、RA-7和RA-8进行敏感性和特异性分析，并探讨其对于RA，尤其早期RA的诊断价值。结果①对于病程≤2年的早期RA患者，1987年ACR标准、RA-6、RA-7和RA-8的敏感性分别为82．0％、91．0％、87．0％和87．0％，特异性分别为95．6％、83．9％、95．6％和95．6％。②在全部RA患者中，1987年ACR标准、RA-6、RA-7和RA-8的敏感性分别为92．3％、96．8％、94．6％和94．6％，特异性分别为92．8％、83．6％、92．8％和92．8％。结论1987年ACR的RA分类标准对早期RA诊断的敏感性较低。RA-6可以提高诊断的敏感性，但是特异性降低。RA-7和RA-8在提高敏感性的同时并不降低特异性，两者具有相同的诊断价值，但是，RA-7更简便实用，可能对RA诊断有参考意义。

Objective To revise the American College of Rheumatology classification criteria for rheumatoid arthritis （RA） with anti-cyclic citrullinated peptide （anti-CCP） antibodies and to evaluate its utility in the diagnosis of Chinese patients. Methods All patients from the Department of Rheumatology and Immunology of Peking University People＇s Hospital who had arthritis complaints in recent two years were enrolled. Patients were divided into RA group and non-RA group according to the clinical diagnosis by experienced rheumatologists. The diagnostic value of ACR criteria and the anti-CCP revised criteria （RA-6, RA-7 and RA-8） were evaluated by analyzing the clinical and laboratory parameters. Results A total of 604 patients were included in the study. 312 patients were diagnosed as RA and 292 were diagnosed as other rheumatic diseases by rheumatologists. For those patients who had disease course for less than 2 years, the sensitivity of 1987 ACR criteria, RA-6, RA-7 and RA-8 criteria was 82.0%, 91.0%, 87.0% and 87.0%, respectively. The specificity of them was 95.6%, 83.9%, 95.6% and 95.6%, respectively. The sensitivity of 1987 ACR criteria, RA-6, RA-7 and RA-8 criteria for all the RA patients was 92.3%, 96.8%, 94.6% and 94.6%, respectively. The specificity of them was 92.8%, 83.6%, 92.8% and 92.8%, respectively. Conclusion The 1987 ACR criteria have high sensitivity and specificity in established RA, but its sensitivity in early RA is low. The RA-6 criteria can improve the sensitivity dramatically but with reduced specificity. The RA-7 criteria can increase the sensitivity without sacrifice the specificity, especially in early RA patients. It may be used as a new set of classification criteria in clinical practice.