抗CCP、RF、CRP、ASO对类风湿关节炎的诊断意义

The significance of serum anti-CCP antibody,RF,CRP,ASO in the diagnosis of rheumatoid arthritis.

目的探讨抗环瓜氨酸肽(CCP)抗体、类风湿因子(RF)、C反应蛋白(CRP)、抗链球菌溶血素"O"(ASO)对类风湿关节炎(RA)的诊断意义。方法收集115例RA患者和131例非RA的自身免疫病患者的血清,用酶联免疫吸附试验检测抗-CCP抗体,免疫比浊法检测RF、CRP、ASO。结果抗CCP、RF、CRP的阳性率在RA组显著高于非RA组,抗-CCP对RA的敏感性为65.2%,CRP对RA的敏感性70.0%,RF的敏感性较抗-CCP和CRP稍低,为60.9%。特异性以抗CCP为最高93.9%,RF对RA的特异性为80.3%,CRP较低为58.0%,经统计学检验,抗CCP的灵敏性与RF、CRP无统计学差异;其特异性比RF、CRP高;ASO在RA组的阳性率很低(12.5%),和非RA组的9.2%相比较无统计学差异。结论 抗CCP对RA的诊断具有较高的灵敏性和特异性,联合检测抗CCP、RF和CRP可进一步提高对RA的诊断鉴别诊断,ASO对RA的诊断意义不大,可作为了解RA病人是否因感染链球菌的指标。

Objective To investigate the significance of serum anti-cyclic citrullinated peptide（CCP） antibody,C-reactive protein（CRP）,antistreptolysin O（ASO） and rheumatoid factor（RF） in the diagnosis of rheumatoid arthritis（RA）.Methods CCP was detected in serum samples from 115 patients with RA by ELISA and compared with serum samples from 131 cases of undifferentiated inflammatory arthritis（UIA） patients.CRP,ASO and RF were detected by immunoturbidimetry method.Results In RA,the positive rates of anti-CCP,CRP and RF were higher than UIA.The sensitivities of anti-CCP,CRP and RF for RA were 65.2%,70.0% and 60.9%,respectively.The specificities of anti-CCP,RF and CRP for RA were 93.9%,80.3% and 58.0%,respectively.Statistical test indicated that there were no significant differences in sensitivities of anti-CCP,CRP and RF,but the specificity of CCP was higher than those of RF and CRP for the diagnosis of RA.The positive rate of ASO in RA was only 12.5% and no significant difference in the positive rate of ASO between RA and UIA was found.Conclusion The anti-CCP assay has high sensitivity and specificity for the diagnosis of RA and the combined detection of anti-CCP,CRP and RF may further improve the sensitivity.ASO has no significance for the diagnosis of RA,but it can be an indication of streptococcal infection in RA patients.