四项检测指标对类风湿关节炎的临床诊断价值

Clinical diagnostic value of determination of four tests for rheumatoid arthritis

目的探讨抗环瓜氨酸肽(CCP)抗体、类风湿因子(RF)、高敏C反应蛋白(hs-CRP)和红细胞沉降率(ESR)检测对类风湿关节炎的临床诊断价值。方法检测75例类风湿性关节炎(RA)患者、45例非RA的风湿病患者和30例健康体检者的血清hs-CRP、ESR、抗CCP抗体和RF水平;比较抗CCP抗体和RF敏感性、特异性、阳性预测值和阴性预示值;测定RA患者的实验室指标。结果RA组和非RA组抗CCP抗体、RF、hs-CRP、ESR明显高于健康对照组(P<0.01);RA组抗CCP抗体和RF水平均高于非RA组(P<0.05),而RA组的hs-CRP和ESR水平与非RA组无明显差异(P>0.05);两者联合检测的特异性和阳性预测值均明显高于单独检测(P<0.05);抗CCP抗体阳性的RA患者CRP、ESR均高于阴性者(P<0.05)。结论 联合检测抗CCP抗体和RF有利于提高RA检测的特异性,对RA的早期诊断有意义;抗CCP抗体对疾病活动的判断有重要意义。

Objective To study the diagnostic value of detection of high-sensitivity C-reactive protein（hs-CRP）,erythrocyte edimentation rate（ESR）,anti-cyclic cit rullinated peptide antibody（anti-CCP antibody） and rheumatoid factor（RF） in the diagnosis of rheumatoid arthritis.Methods Select 75 cases of rheumatoid arthritis（RA）,45 cases of non-RA rheumatic diseases and 30 cases of healthy individuals.ESR,hs-CRP,RF and anti-CCP antibody were detected;compared the sensitivity,specificity,positive predictive value and negative predictive value of RF and anti-CCP antibody;then some clinical parameters of RA cases were recorded.Results The results of ESR、hs-CRP、RF and anti-CCP antibody in RA patients were significantly higher than that in other groups（P0.01）,the levels of RF and anti-CCP antibody in RA patients were higher than that in non-RA rheumatic diseases（P0.05）,the levels of ESR and hs-CRP in the RA patients were no significant difference from the non-RA patient＇s（P0.05）;The specificity and the positive predictive value of combined detection of anti-CCP antibody and RF were significantly higher than Single detection（P0.05）;The levels of ESR and hs-CRP in anti-CCP antibody positive patients were higher than those of anti-CCP antibody negative patients（P0.05）.Conclusion Combined detection of anti-CCP antibody and RF will improve the specificity of RA detection,and it is good for the early diagnosis of RA;anti-CCP antibody is very significant in judgement of RA activity.