抗CCP抗体、抗角蛋白抗体及类风湿因子联合检测在类风湿关节炎诊断中的应用

Application of combined detection of anti-CCP, RF, and AKA in the diagnosis of rheumatoid arthritis

目的 评价抗环瓜氨酸多肽抗体（anti-CCP）、类风湿因子（RF）、抗角蛋白抗体（AKA）的单一及联合检测在类风湿关节炎（RA）诊断中的应用价值.方法 前瞻性研究.随机表法选取2011年1月至2013年9月于北京大学第三医院就诊的门诊及住院的137例RA患者,265例非RA的自身免疫患者,111名健康人,检测血清中AKA、anti-CCP抗体及RF的水平.其中AKA测定采用间接免疫荧光法;RF测定采用速率散射比浊法;anti-CCP测定采用电化学发光法.检测方案分为单项目、双项目、三项目检测,一共18种方案.检测结果组间比较采用四格表卡方（x2）检验.结果 Anti-CCP检测的准确度（80.39％）,YI（0.51）,和κ值（0.55）在单项目检测方案中均最高.方案antiCCP＋ （AKA/RF）,AKA/（anti-CCP＋ RF）,和（AKA＋ RF）/（anti-CCP＋ RF）/（AKA＋ anti-CCP）的准确度（80.94,80.94,80.66）,YI（0.51,0.51,0.50）,和κ值（0.55,0.56,0.54）在联合检测方案中最高.结论 Anti-CCP检测在辅助RA诊断中具有突出的价值.联合检测方案anti-CCP＋（AKA/RF）、AKA/（anti-CCP＋ RF）、与（AKA＋ RF）/（anti-CCP＋ RF）/（AKA＋ anti-CCP）对于RA的诊断最有价值.

Objective To investigate the application of combined detection of three serum markers,anti-cyclic citrullinated peptide antibody （anti-CCP）,rheumatoid factor （RF）,anti-keratin antibodies （AKA）,for the diagnosis of rheumatoid arthritis.Methods This was a prospective study.Serum samples were randomly obtained from 137 RA patients,265 other autoinmmune diease patients,and 111 normal controls.All of the volunteers were outpatients or inpatients of Peking University Third Hospital from January 2011 to September 2013.Levels of AKA,anti-CCP antibody,RF were measured by indirect immunofluorescence,chemiluminescence,and immune turbidimetry,respectively.The values of 3 serum biomarkers and their varied combinations for RA diagnosis were systemically assessed.The results were compared using fourfold table chi-square （x2） test.Results When using one serum marker,anti-CCP had the highest accuracy （80.39％）,Youden＇s index （YI） （0.51）,and Kappa （κ） value （0.55） for the diagnosis of RA.While using three serum markers,anti-CCP ＋ （AKA/RF）,AKA /（anti-CCP ＋ RF）,anti-CCP/（AKA ＋ RF） and （AKA ＋ RF）/（anti-CCP ＋ RF）/（AKA ＋ anti-CCP） had the highest accuracy （80.94,80.94,80.66）,YI （0.51,0.51,0.50）,and κ value （0.55,0.56,0.54）.Conclusion AntiCCP is the vital marker for RA diagnosis.Anti-CCP ＋ （AKA/RF）,AKA/（anti-CCP ＋ RF）,and （AKA ＋RF）/（anti-CCP ＋ RF）/（AKA ＋ anti-CCP） are the most ideal combinations for RA diagnosis.