抗聚角蛋白微丝蛋白抗体的检测在类风湿关节炎诊断中的意义

Diagnostic value of antibodies to filaggrin in patients with rheumatoid arthritis

目的 探讨抗聚角蛋白微丝蛋白抗体 (AFA)对RA诊断的意义 ,并比较其与抗核周因子抗体 (APF) ,抗角蛋白抗体 (AKA)以及HLA DR4之间的相关性。方法 用免疫印迹法 (WB)检测 15 7例类风湿关节炎 (RA)血清标本和 10 4例对照血清 ,包括系统性红斑狼疮 (SLE)、干燥综合征(SS)、骨关节炎 (OA)等的AFA。APF和AKA用间接免疫荧光法检测。结果 15 7例RA病人的AFA敏感性和特异性分别为 36 3% ,93 4% ,与疾病对照组和正常对照组相比 ,差异有显著性 (P <0 0 5 )。 5 7例AFA阳性的血清中 ,其中AKA同时阳性的有 36例 ,重叠率为 6 3 2 % ;APF同时阳性的有 38例 ,重叠率为 6 6 7% ;HLA DR4同时阳性的有 30例 ,重叠率为 5 2 6 %。统计学分析证实AFA与AKA、APF及HLA DR4之间有相关性。结论 AFA对RA具有很高的特异性 ,可用于RA的临床诊断。AFA与APF、AKA及HLA DR4有相关性。AFA不能完全替代APF和AKA ,三项临床检测可互相补充 。

Objective To determine the diagnostic value of antifilaggrin antibodies (AFA) in patients with rheumatold arthritis (RA) and compare the correlation among AFA,anti perinuclear factor (APF),anti keratin antibodies (AKA) and HLA DR4.Methods Antifilaggrin autoantibodies were assayed in 157 serum samples from patients with RA and 140 serum samples from other rheumatic diseases,using Western blot (WB).APF and AKA were tested in the same series of RA patients by indirect immunofluorescence HLA DR4.was detected by PCR.Results The diagnostic sensitivity of the AFA was 36 3% with a specificity of 93 4%,The result was significantly higher than that of the controls ( P <0 05).Out of 57 AFA positive sera,36,38 and 30 (63 2%,66 7% and 52 6%) were positive in AKA,APF and HLA DR4 tests,respectively.AFA was associated with APF,AKA and HLA DR4.Conclusion AFA presents extreme specificity and diagnostic value in rheumatoid arthritis.There is a positive association between AFA,APF,AKA and HLA DR4.AFA dose not completely overlap with APF and AKA.Nevertheless,combining the AFA with AKA or AKA could enhance the diagnostic performance of RA.