RF、GPI、抗CCP抗体联合检测对类风湿关节炎的诊断意义

Diagnostic value of rheumatoid factor,glucose-6-phosphate isomerase and anti-cyclic citrullinated peptide antibodies for the patients with rheumatoid arthritis

目的:研究类风湿因子(rheumatoid factor,RF)、葡萄糖-6-磷酸异构酶(glucose-6-phosphate isomerase,GPI)和抗环瓜氨酸肽(anti-cyclic citrullinated peptide,anti-CCP)抗体联合检测对类风湿关节炎(rheumatoid arthritis,RA)的诊断意义。方法:收集未经治疗的128例RA患者(RA组)、117例其他风湿病人(非RA组)、74例健康人(正常对照组)血清,采用酶联免疫吸附法(ELISA)检测GPI、抗CCP抗体,采用速率散射比浊法检测RF、C反应蛋白(CRP)、补体(C3、C4)、免疫球蛋白(IgA、IgG、IgM),采用魏氏法测红细胞沉降率(血沉,ESR)。结果:(1)GPI、抗CCP抗体诊断RA的特异性分别为91.09%、94.14%,与RF(78.53%)比有显著差异(P<0.01),敏感性分别为75.0%、75.8%,与RF(80.47%)比无统计学差异(P>0.05)。(2)GPI和RF、抗CCP抗体和RF、GPI和抗CCP抗体两两组合检测,两个指标均为阳性诊断RA的特异性分别为94.24%、95.81%、96.34%,与单独检测RF比有显著差异(P<0.01);两个指标任一阳性诊断RA的敏感性分别为85.16%、85.94%、87.50%,与单独检测RF比无统计学差异(P>0.05),但与单独检测GPI或抗CCP抗体比有统计学差异(P<0.05)计学。(3)三个指标联合检测均为阳性诊断RA的特异性高达98.43%,与单独检测RF、GPI或抗CCP抗体比有统计学差异(P=0.000,P=0.001,P=0.018),任一阳性诊断RA的敏感性为91.41%,与单独检测RF、GPI或抗CCP抗体比有统计学差异(P=0.012,P=0.000,P=0.001)。(4)GPI阳性的RA患者关节炎部位数、CRP、ESR水平明显高于GPI阴性RA患者,且差异有统计学意义(P<0.05)。结论:GPI、抗CCP抗体诊断RA比RF更具特异性,三者联合检测可显著提高诊断RA的特异性和敏感性。此外,GPI还可作为RA活动性指标。

Objective：To research the dignostic value forthe patients with rheumatoid arthritis （RA） by examing rheumatoid factor（RF）, glucose-6-phosphate isomerase（GPI） and anti-cyclic citrullinated peptide （anti-CCP） antibodies jointly.Method：GPI, anti-CCP antibody levels were detected by enzyme-linked immunosorbent assays （ELISAs） in the serum of 128 patients with rheumatoid arthritis （RA group ）, 117otherrheumatic diseases （non-RA group ） , and 74 healthy subjects （normal control group ） .RF, C-reactive protein （CRP） , Complement 3 （C3） , Complement 4 （C4）, Immunoglobulin A （IgA ） , Immunoglobulin G （IgG ） , Immunoglobulin M （IgM ） were examined with rate scatter nephelometry .Erythrocyte sedimentation rate （ESR） was determined by Westergren method.Results：（1）Comparing with RF （78.53%） , the specificity of GPI （91.09%） oranti-CCP （94.14%） increased significantly （P0.01）.Comparing with RF （80.47%）, the sensitivity of GPI（75.0%） oranti-CCP （75.8%） had no statistical significance.（2）Comparing with RF, the specificity of both GPI and RF（94.24%）, anti-CCP and RF（95.81%）, or GPI and anti-CCP（96.34%） increased significantly （P0.01）, when both index were positive simultaneous.And the sensitivity of the three groups （85.16%,85.94%,87.50%respectively） had no statistical significance comparing with RF,but increased （p0.05） comparing with GPI oranti-CCP, when eitherindex was positive.（3）Comparing with RF,GPI oranti-CCP ,the specificity （98.88%） inceased significantly （P=0.000,P=0.001,P=0.018） and the sensitivity （91.06%） inceased significantly （P=0.012, P=0.000, P=0.001）, when GPI, anti-CCP and RF were detected simultaneously.（4）The GPI positive group had higher levels with arthritis parts,ESR,CRP than the GPI negative group in the patients of RA.Conclusions：The specificity of GPI and anti-CCP were higherthan RF.Both sensitivity and specificity of detection were improved when the combined detection of GPI, anti-CCP and RF was used in the patients with RA .And GPI was one of the Rheumatoid Activity Markers.