6种抗体联合检测类风湿性关节炎的临床意义

Clinical significance of combined detection of six kinds of antibodies in rheumatoid arthritis patients

目的比较类风湿因子(RF-IgM,IgA,IgG)、抗角蛋白抗体(AKA)、抗核周因子(APF)、抗环胍氨酸肽抗体(anti-CCP)诊断类风湿性关节炎(RA)的敏感性及特异性,并探讨6种联合检测对RA诊断的意义。方法采用ELISA检测RF-3(RF-IgM,IgA,IgG)和抗CCP抗体,间接免疫荧光法检测AKA和APF。共检测76例RA患者、98例非RA患者和30例健康者。结果 RF-IgM、RF-IgA、RF-IgG、AKA、APF和抗CCP对RA的敏感性分别为71.1%、44.7%、28.9%、42.1%、48.7%、68.4%,特异性分别为78.9%、85.9%、89.1%、89.8%、91.4%、93.8%。联合检测3种抗体、4种抗体、5种抗体和6种抗体,敏感性及特异性分别是RF-3(RF-IgG,IgA,IgM)为27.6%和92.2%,RF-3/AKA为19.7%和94.5%,RF-3/APF为23.7%和96.1%,RF-3/抗CCP抗体为26.3%和96.1%,RF-3/AKA/APF为18.4%和97.7%,RF-3/AKA/抗CCP抗体为15.8%和99.2%,RF-3/APF/抗CCP抗体为15.8%和99.2%,RF-3/AKA/APF/抗CCP抗体为13.2%和100.0%。结论诊断RA的6种相关抗体中RF-IgM的敏感性最高,但特异性最低;抗CCP的特异性最好,抗CCP最具诊断价值;RF与AKA、APF、抗CCP联合检测可进一步提高对RA诊断的特异性,对RA的早期诊断具有重要的应用价值。

Objective To investigate the value detection of rheumatoid factors（RF-IgM,IgA,IgG）,anti-keratin antibody（AKA）,anti-perinuclear factor（APF） and anti-cyclic citrullinated peptide antibody（CCP） in diagnosis of rheumatoid arthritis（RA）. Methods Enzyme immunoassay was used for detection of rheumatoid factor（RF-IgM,IgA,IgG）,cyclic citrullinated peptide antibody（CCP）;indirect immunofluorescence（IIF）was used for detection of anti-keratin antibody（AKA）and anti-perinuclear factor（APF）in 76 patients with RA,98 cases of non-RA patients and 30 healthy controls. Results The sensitivities in detection of RF（IgM,IgA,IgG）AKA,APF,and anti-CCP were 71.1 %,44.7%,28.9%,42.1%,48.7%and 68.4%,respectively and the specificities were 78.9%,85.9%,89.1%,89.8%,91.4% and 93.8% respectively.The sensitivity and specificitiy of combined detection of RF-IgM,IgA and IgG were 27.6 % and 92.2%,that of combined detection of RF-IgM,IgA,IgG and AKA were 19.7% and 94.5%%,that combined detection of RF-IgM,IgA,IgG and APF were 23.7% and 96.1%%,that of combined detection of RF-IgM,IgA,IgG and anti-CCP were 26.3% and 96.1%,that of combined detection of RF-IgM,IgA,IgG,AKA and APF were 18.4% and 97.7%,that of combined detection of RF-IgM,IgA,IgG,AKA and anti-CCP were 15.8% and 99.2%,that of combined detection of RF-IgM,IgA,IgG,APF and anti-CCP were 15.8% and 99.2%,and that of combined detection of RF-IgM,IgA,IgG,AKA,APF and anti-CCP were 13.2% and 100%.Conclusion In comaprison of detection of six antibodies,the sensitivity is the highest in detection of RF-IgM,with the lowest specificity;The specificity in detection of CCP is the highest,possessing diagnostic value and the most valuable.Combined detection of the six auto-antibodies will improve the specificity in early daignosis of RA.