类风湿关节炎四种自身抗体的检测及意义

Significance of Determination of Four Autoantibodies for Diagnosis of Rheumatoid Arthritis

为评估类风湿因子(rheumatoid factor,RF)、抗环瓜氨酸肽(cyclic citrullinated pepdide,CCP)抗体、抗Sa抗体和抗角蛋白抗体(anti-keratin antibody,AKA)自身抗体对类风湿关节炎(rheumatoid arthritis,RA)诊断的意义,采用速率散射比浊法定量测定RF、ELISA法定量测定抗CCP抗体、免疫印迹法检测抗Sa抗体、间接免疫荧光法检测AKA,检测了123例诊断明确的类风湿关节炎患者、105例其他结缔组织病患者和78名键康人血清样本。结果显示:RF、抗CCP抗体、抗Sa抗体和AKA的诊断敏感性分别为62.6%、69.9%、35.8%和33.3%,RF的诊断特异性(79.8%)显著低于其它三种自身抗体(94.5%、95.6%和95.6%,P<0.01);RF阴性患者的抗CCP抗体、抗Sa抗体和AKA阳性率分别为41.3%、15.2%和13.0%,RF与抗CCP抗体检测的阳性符合率为49.6%,具有较高的一致性(kappa值0.501)。因此,同时检测两种以上靶抗原不同的自身抗体可显著提高RA的诊断率,并可以发现不同个体RA病程中自身抗体表达的差异。

To investigate the diagnostic significance of four autoantibodies including rheumatoid factor（RF）,anticyclic citrullinated peptide（CCP） antibody,anti-Sa antibody,and anti-keratin antibody in rheumatoid arthritis（RA）,the serum sample of 123 patients with RA,105 patients with non-RA connective disease and 78 healthy subjects were involved in this study.RF and anti-CCP were quantitatively measured by velocity scattering turbidimetry and enzyme linked immunosorbent assay（ELISA） respectively.Anti-Sa antibody and AKA were detected by western-blotting and indirect immunofluorescence respectively.The results showed that the positive rate of RF,anti-CCP,anti-Sa and AKA for RA were 62.6%,69.9%,35.8% and 33.3%,respectively.The specificity for RF（79.8%） was significant lower than that of other three autoantibodies（94.5%,95.6% and 95.6%,P〈0.01）.The positive rates of anti-CCP,anti-Sa and AKA for RF negative patients were 41.3%,15.2% and 13.0% respectively.The positive coincident rate of RF and anti-CCP were 49.6% and kappa value was 0.501.The detection of more than two autoantibodies may greatly improve the specificity of RA diagnosis and could find the difference of expression of autoantibodies in different individuals during RA course.