AKA、抗CCP、抗RA33抗体和APF联合检测在类风湿性关节炎早期诊断中的临床应用

Combined detection of antikeratin antibody,anti-cyclic citrullinated peptide antibody,anti-RA33 antibody and anti-perinuclear factor in early diagnosis of rheumatoid arthritis

目的通过比较抗角蛋白抗体(AKA)、抗环瓜氨酸肽抗体(anti-CCP)、抗RA33抗体和抗核周因子抗体(APF)诊断类风湿性关节炎(RA)的敏感性和特异性,探讨四者联合检测在RA诊断中的临床意义。方法对98例RA患者,56例RA疑似患者和148例非RA的风湿性疾病患者的血清进行AKA、抗CCP、抗RA33和APF检测,并对其敏感性、特异性和差异性进行统计学分析。结果 AKA、抗CCP、抗RA33和APF四种抗体在RA组的检出率分别为53.1%、66.3%、34.7%、31.6%,联合检出率为94.9%;特异性分别为97.97%,94.59%,95.95%,99.32%,联合检测特异性为87.84%。在RA疑似组中检出率分别为16.1%,23.2%,8.9%,3.6%,联合检出率为39.3%。非RA疾病组中检出率分别为2.0%,5.4%,4.1%,0.7%。在RA组中联合检测的敏感性显著高于单项检测(P<0.05),而特异性无显著差异。RA组中四种抗体的阳性率显著高于RA疑似组和非RA疾病组(P<0.01)。四种抗体联合检测的阳性率在RA疑似组中显著高于非RA疾病组(P<0.01)。结论四种抗体联合检测能显著提高对RA疾病诊断的敏感性,同时不影响其特异性;四种抗体联合检测在RA疑似组中的高阳性率提示四种抗体对RA的早期诊断具有重要的临床意义。

Objective To compare the sensitivity and specificity of antikeratin antibody （AKA）, anti-cyclic citrullinated peptide（ anti- CCP） ,anti-RA33 antibody and anti-perinuclear factor（APF） in diagnosis of rheumatoid arthritis（RA） ,and to explore the clinical sig- nificance of combined detection. Methods The serum levels of AKA,anti-CCP,anti-RA33 and APF in 98 cases of RA,56 RA sus- pected cases and 148 cases of other rheumatic diseases were detected, and the sensitivity, specificity and difference were statistically an- alyzed. Results The detection rates of AKA,anti-CCP,anti-RA33 and APF in RA group were 53.1%,66.3%,34.7%,31.6%,and the combined detection rate was 94.9% ;The specificities were 97.97%,94.59%,95.95% ,99.32% for RA patients,and the specifici- ty of combined detection was 87.84%. The detection rates of AKA,anti-CCP,anti-RA33 and APF were 16.1% ,23.2% ,8.9% ,3.6% in RA suspected group, and the combined detection rate was 39.3%. The detection rates of AKA, anti-CCP, anti-RA33 and APF in oth- er rheumatic disease group were 2.0% ,5.4% ,4.1% ,0.7%. The sensitivity of the combined detection in RA group was significantly higher than that of single detection （ P 〈 0.05 ）, but the specificity showed no significant difference. The positive rates of the four anti- bodies in RA group were significantly higher than those in RA suspected group and other rheumatic disease group （ P 〈 O. 01 ）. The combined detection rate of the four antibodies in RA suspected group was significantly higher than that in other rheumatic disease group （ P 〈 0. O1 ）. Conclusion The combined detection of the four antibodies can significantly improve the sensitivity in the diagnosis of RA, but do not affect the specificity. The high positive rates of combined detection of four antibodies in RA suspected patients suggest that the combined detection of the four antibodies has important clinical significance in the early diagnosis of RA.