多种自身抗体在老年类风湿关节炎诊断中的临床应用价值

Value of a variety of autoantibodies in the diagnosis of elderly rheumatoid arthritis

目的:探讨抗环瓜氨酸(CCP)抗体、抗角蛋白(AKA)抗体、抗核周因子(APF)和RA33抗体在老年起病类风湿关节炎(EORA)诊断和鉴别诊断中的临床意义。方法:对95例EORA(EORA组)、69例风湿性多肌痛(PMR)患者(PMR组)和47例健康者(对照组)进行抗CCP抗体、AKA、APF和RA33抗体检测,其中抗CCP抗体和RA33抗体采用酶联免疫吸附法(ELISA法)检测,AKA和APF采用间接免疫荧光法(ⅡF)法检测。结果:①抗CCP抗体、AKA、APF和RA33抗体在EORA组的敏感性和特异性分别为(58.9%、95.8%)、(33.7%、91.4%)、(31.6%、89.4%)和(36.8%、86.7%),显著高于PMR组和对照组(P<0.01)。②EORA组抗CCP抗体的敏感性显著高于AKA、APF和RA33抗体(P<0.05)。联合检测4种抗体,敏感性有所降低,但使阳性率提高至98.9%,且有更高的阳性预测值。③69例PMR患者中有6例患者CCP抗体阳性,3例AKA阳性,且与CCP抗体相重叠,2例APF阳性,2例RA33阳性,1年后3例重叠阳性的PMR患者确诊为EORA。结论:PMR与EORA有相似的临床症状和特征,临床上有时难以鉴别,极少数病例,在早期不典型时易误诊,但抗CCP抗体、AKA、APF和RA33抗体仍主要出现在EORA患者中,尤其抗CCP抗体有较高的敏感性和特异性,4种抗体联合检测有更高的特异性和阳性预测值,同时结合临床症状、影像学改变等,4种抗体联合检测对EORA的诊断和鉴别诊断有很高的临床应用价值。

Objective：To evaluate the value of anti-CCP, AKA, APF and anti-RA33 in the diagnosis and differential diagnosis of elderly -onset rheumatoid arthritis （EORA）. Methods：Serum anti-CCP and anti-RA33 in 95 EORA patients,69 patients with polymyalgia rheumatica （PMR） and 47 healthy controls were measured by enzyme-linked immtuuosorbed assay （ELISA）and the levels of AKA and APF were measured by indirect immnuofluorescenee （IIF）. Results：（1）The specificity and sensitivity of anti-CCP in EORA group was 58. 9%and 95. 8% ,AKA was 33.7% and 91.4% ,APF was 31.6%and 89.7% and anti-RA33 was 36.8%and 86.7%. The specificity and sensitivity of anti-CCP, AKA, APF and anti-RA33 in EORA group was significantly higher than that in PMR and control group（ P 〈0.01）. （2）In EORA group, the sensitivity of anti-CCP was significantly higher than that of AKA,APF and anti-RA33 （ P 〈0.05）. Combined detection of these four antibodies increased the positive rate to 98. 9%, and offered higher positive predictive value（PPv）. （3）Among 69 PMR patients ,6 were anti-CCP positive, 3 AKA positive With overlapping anti-CCP positive, 2 APF positive, 2 RA33 positive. After 1 year, 3 PMR patients with the overlapping positive antibodies developed to EORA. Conclusion： PMR and EORA have similar clinical symptoms and characteristics, so sometimes it is difficult to be distinguished in clinical. Few of eases may be misdiagnosed because of nonrepresentative symptoms during the early period. But anti-CCP, AKA, APF and anti-RA33 still appear mainly in EORA patients. Anti-CCP detection has high sensitivity and specificity. Combined detection of these four antibodies would have higher specificity and PPv. Combined with clinical symptoms and imaging changes, combined detection of these four antibodies would have higher clinical value in the diagnosis and differential diagnosis of EORA.