类风湿关节炎相关抗体测定及其临床实用性的研究

Significance of detection of the autoantibodies in patients with rheumatoid arthritis

目的探讨类风湿关节炎相关抗体测定及临床意义。方法随机选人于本科住院治疗的RA患者500例，应用免疫比浊法检测RF-IgM，酶联免疫吸附法检测HRF-IgG、HRF-IgA及antiCCP抗体，间接免疫荧光染色法检测APF和AKA，分析总结上述抗体及其联合检测在RA诊断中的合理应用。结果（1）500例RA患者血清中自身抗体RF-IgM、anti-CCP、APF、HRF-IgG、AKA、HRFIgA检出的敏感性分别为78．0％、70．8％、51．8％、48．4％、45．O％、20．0％。以RF-IgM检出率最高，其次为anti-CCP。（2）在110例RF-IgM阴性的患者中anti—CCP、APF、AKA、HRF．IgG、HRF．IgA抗体的阳性检出率分别为41．8％、27．3％、22．7％、15．5％、1．8％，尤以anti-CCP的互补作用最好。（3）在146例anti-CCP抗体阴性的患者中RF-IgM、HRF-IgG、APF、AKA、HRF-IgA抗体的阳性检出率分别为56．8％、24．7％、16．4％、8．9％、7．5％。（4）RF-IgM和（或）anti-CCP和（或）APF三种抗体联合和RF-IgM和（或）anti-CCP和（或）HRF-IgG三种抗体联合检出的敏感性最高，分别为88．6％、88．4％，显著优于抗体的单独检测（P〈0．05或P〈0．01），抗体间的联合检测能增加检出的敏感性（P〈0．05或P〈0．01）。结论四种自身抗体在RA中诊断的敏感性以RF-IgM、anti-CCP较为突出且二者的联合检测可提高RA诊断的敏感性。

Objective To explore the sensitivity of antibodies against RF, APF, AKA, anti-CCP in rheumatoid arthritis （ RA ） and analyze the relationship between these autoantibodies in RA. Methods Five hundreds of RA patients were studied. Immunoturbidmetry was used to measure the RF-IgM. The en- zyme-linked immunosorbent assay （ELISA） was used to measure the HRF-IgG, HRF-IgA and anti-CCP. Indirect immunofluorescence was used to measure the APF and AKA. Results The seropositive rates of RF-IgM, anti-CCP, APF, HRF-IgG, AKA and HRF-IgA were 78.0%, 70. 8%, 51.8%, 48.4%, 45.0% and 20. 0% respectively. RF-IgM could not be detected in 110 patients while the seropositive rates of anti-CCP, APF, AKA, HRF-IgG and HRF-IgA were 41.8%, 27. 3%, 22. ：/%, 15.5% and 1.8% respectively. Anti-CCP could not be detected in 146 patients while the seropositive rates of RF-IgM, HRF- IgG, APF, AKA and HRF-IgA were 56. 8%, 24. 7%, 16.4%, 8.9% and 7.5% respectively. The combined sensitivities of RF-IgM anti-CCP and APF were higher than others. The seropositive rates were 88.6%. Conclusions RF-IgM and anti-CCP are sensitive antibodies for diagnosis of RA. Combinations RF-IgM with anti-CCP can significantly improve the sensitivity of diagnosis of RA.