13715例抗环瓜氨酸肽抗体和抗角蛋白抗体检测临床分析

Detection of Anti-cyclic Citrullinated Peptide Antibodies and Anti-keratin Antibodies in 13715 Specimens and Its Clinical Significance

目的探讨抗环瓜氨酸肽抗体(抗CCP抗体)和抗角蛋白抗体(AKA)在临床就诊患者疾病分布及在类风湿关节炎(RA)诊断中的临床意义。方法分别采用酶联免疫吸附试验(ELISA)法和间接免疫荧光法(IIF)检测13 715例患者血清抗CCP抗体和血清AKA,分析抗CCP抗体的疾病分布和在不同疾病中的阳性率。结果 13 715例中,抗CCP抗体阳性率为30.02%,男性为25.41%,女性为31.60%;在2716例确诊RA、3808例疑似RA的关节炎/关节痛患者和1909例确诊其他非RA患者中,抗CCP抗体阳性率为34.74%,高于AKA 16.71%的阳性率,差异有统计学意义(χ2=2810.0,P=0.00),两者的一致性中度(K=0.52,P=0.00)。抗CCP抗体对RA的敏感性为64.10%,特异性为85.4%;AKA对RA的敏感性为32.29%,特异性为93.92%。抗CCP抗体诊断RA的敏感性高于AKA(P<0.05),特异性低于AKA(P<0.05)。抗CCP抗体与AKA联合检测RA特异性为94.55%。RA患者抗CCP抗体阳性率为64.10%,干燥综合征(SS)、银屑病关节炎(PsA)、骨关节炎(OA)和系统性硬化症(SSc)患者中抗CCP抗体阳性率分别为36.69%、25.00%、18.60%和18.60%,在白塞病(BD)和成人斯蒂尔病(AOSD)中抗CCP抗体阳性率为0。结论抗CCP抗体主要出现于RA患者,抗CCP抗体可以满足临床对RA患者的筛查,对于抗CCP抗体检测结果与临床表现不符合的患者有必要进行AKA检测,减少漏诊和误诊。

Objective To explore the disease distribution of anti-cyclic citrullinated peptide（anti-CCP）antibodiesand anti-keratin antibodies（AKA）and their significance in rheumatoid arthritis（RA）. Methods Anti-CCP antibod-ies in 13 715 specimens were measured by ELISA from the Department of Clinical Laboratory, Taizhou CentralHospital from 2006.9 to 2011.9, and AKA were measured by indirect immunofluorescence（IIF）. The disease distri-bution of anti-CCP antibodies and its positive rate in different disease were analyzed, and the significance of anti-CCP antibodies and AKA in patients with RA was explored. Results Of the 13 715 specimens, the positive rate ofanti-CCP antibodies was 30.02%. The positive rate of anti-CCP antibodies in male patients was statistically lowerthan that in female（25.41% vs. 31.60%, 2=47.7, P=0.00）. In 2716 patients diagnosed as having RA, 3808 patientssuspected RA with arthritis∕joint pain, and 1909 patients diagnosed with other non-RA, the positive rate of anti-CCP antibodies was 34.74%, which was statistically higher than that of AKA（16.71%, χ2=2810.0, P=0.00）. Consis-tency of anti-CCP antibodies and AKA was moderate（K=0.52, P=0.00）. The sensitivity of anti-CCP antibodies toRA was 64.10%, the sensitivity of AKA to RA was 32.29%, a significant difference was found between them（χ2=550.4, P=0.00）; The specificity of anti-CCP antibodies to RA was 85.4%, while that of AKA was 93.92%, a sig-nificant difference was observed between them（χ2=74.3, P=0.00）. The specificity of combination of anti-CCP anti-bodies and AKA was 94.55%. The positive rate of anti-CCP antibodies in RA patients was 64.10%, and it alsopresented in 36.69% of sicca syndrome, 25.00% of psoriatic arthritis, 18.60% of osteoarthritis and 18.60% of sys-tematic systematic sclerosis. The positive rate of anti-CCP antibodies in bechet disease and adult onset Still＇s dis-ease was 0. Conclusions The presence of anti-CCP antibodies was more seen in patients with RA. Detection ofanti-CCP antibodies could meet the requirements of clinical screening of RA. But when the results of anti-CCPantibodies are inconsistent with clinical manifestations, it is needed to detect AKA, so as not to lead to misdiagno-sis and missed diagnosis in patients with RA.