抗环瓜氨酸肽抗体、抗核周因子在类风湿关节炎诊断中的意义

To exam anti-cyclic citrullinated peptide antibody and the antiperinuclear factor,and to evaluate the diagnosis method of the early patients with rhematoid arthritis

目的检测抗环瓜氨酸肽(CCP)抗体、抗核周因子抗体(APF)在类风湿关节炎(RA)诊断中的意义,并比较APF、CCP、抗角蛋白抗体(AKA)、抗RA33抗体、类风湿因子(RF)、C反应蛋白及血沉在RA中的意义,并探讨以上7种常用检查项目的联合检测在RA诊断中的实际意义。方法采用ELISA法检测抗CCP抗体,间接免疫荧光法检测APF、AKA,抗RA33抗体及使用速率散射比浊定量法检测RF,点化学发光法检测CRP及魏氏法检测血沉。共检测160例确诊RA患者、90例非RA其它自身免疫病患者及100例正常对照,并结合临床资料进行分析。结果APF、AKA、抗RA33抗体、抗CCP抗体和RF的灵敏度分别为45.6%、33.8%,27.5%,80.0%,62.5%,71.9%及74.4%,特异度分别为94.2%,94.7%,92.1%,90.0%,68.9%,56.8%and 79.2%。RA患者这五种抗体的阳性率均显著高于非RA患者,差异具有统计学意义(P<0.05)。联合检查中,RA阳性组,APF+RF+CCP联合筛查阳性率已经达到95.0%。结论 7种指标在检测RA均有显著意义,APF、抗CCP及RF联合筛查即可获得较高的阳性率,更多指标的联用更有助于早期发现RA患者。

Objective To evaluate the diagnostic value of anti-cyclic citrullinated peptide （anti-CCP）antibody,anti-perinuclear factor （APF）,anti-keratin antibody（AKA）,anti-RA33,henmatoid factor（RF）,Erythrocyte Sedimentation Rate（ESR）and C reactive protein（CRP）in patients with rheumatoid arthritis（RA）.Methods indirect immunofluores-cent staining was used to assay APF and AKA,enzyme linked immunosorbent assays（ELISA）were used to detected anti-RA33 and anti-CCP,RF and CRP was assay with rate nephelometry,ESR was detected by fully automated ESR an-alyzer in 160 RA,in 90 patients with autoallergic disease except RA and 100 normal controls.Results The sensitivity of APF,AKA,anti-RA33,anti-CCP ,CRP,ESR and RF was 45.6%,33.8%,27.5% ,80.0%,62.5%,71.9%and 74.4%.while the specificity was 94.2%,94.7%,92.1%,90.0% ,68.9%,56.8%and 79.2%.Conclusion The APF, AKA,anti-RA33,and anti-CCP are serologic markers for RA as RF.Combined detection of the APF,RF and anti-CCP could have great clinic value in the diagnosis of RA.