抗CCP抗体和RF对类风湿性关节炎诊断价值的比较

Comparison of diagnostic value of anti-cyclic citrullinated peptide antibody and rheumatoid factor in rheumatoid arthritis

目的评价抗环瓜氨酸肽(CCP)抗体和类风湿性关节炎因子(RF)在类风湿性关节炎(RA)中的意义。方法 90例RA患者、30例其他疾病患者和35例健康对照组血清用ELISA法检测抗CCP抗体、免疫散射比浊法检测RF,比较两种抗体单独或联合检测对诊断RA的敏感性、特异性、阳性预测值、阴性预测值、总符合率及Youden指数;通过绘制ROC曲线,计算ROC曲线下面积(AUC)探讨抗CCP抗体和RF的相关性。结果 RA组抗CCP抗体和RF阳性率均高于其他疾患者和健康对照组(P<0.0125);RF诊断RA的敏感性高于抗CCP抗体;抗CCP抗体对诊断RA的其他5项指标均高于RF;抗CCP抗体和RA联合检测对RA的诊断的敏感性明显高于抗CCP抗体、RF两项检测指标;另外,抗CCP抗体和RA联合检测对RA的诊断的阴性预测值,总符合率及Youden指数也高于抗CCP抗体、RF两项检测指标。抗CCP抗体、RF及两者联合检测ROC曲线下面积(AUC)均>0.5,并且抗CCP抗体与RF联合检测AUC大于抗CCP抗体及RF的AUC。结论抗CCP抗体对RA有较高的诊断价值,和RF联合检测对诊断RA有重要意义。

ObjectiveTo evaluate the role of anti-cyclic citrullinated peptide antibody（anti-CCP） and rheumatoid factor（RF） in patients with rheumatoid arthritis（RA）.MethodsAnti-CCP antibody and RF were detected by enzyme linked immunosorbent assay and nephelometry respectively in serum samples of 90 RA patients,30 patients with other diseases and 35 healthy blood donors.The sensitivity,specificity,positive predictive value,negative predictive value,total coincidence rate and Youden＇s index of these parameters for the diagnosis of RA through detecting anti-cyclic citrullinated peptide antibody（anti-CCP） or rheumatoid factor（RF） alone or both of them were compared.The correlation between anti-CCP and RF was inferred by drawing the receiver operative characteristic curve（ROC） and calculating area under the ROC curve.ResultsThe positive rates of anti-CCP and RF in serum samples of 90 RA patients were higher than those of the patients with other diseases and 35 healthy blood donors（P 0.05）.The sensitivity of RF（61.10%） showed difference from anti-CCP（63.30%）,but the sensitivity of anti-CCP in diagnosing other 5 parameters of RA was significantly higher than that of RF.The sensitivity of anti-CCP combined with RF for the diagnosis of RA was significantly higher than that of anti-CCP or RF alone.In addition,the negative predictive value,total coincidence and Youden＇s index of anti-CCP combined with RF were also significantly higher than those of anti-CCP or RF alone.The area under the ROC curve（AUC） of detecting anti-CCP or RF or both of them was larger than 0.5,and the area under the ROC curve（AUC） of detecting anti-CCP combined with RF exceeded that of detecting anti-CCP or RF alone.ConclusionAnti-CCP,especially combined with RF is valuable in diagnosing RA.