联合检测类风湿因子与抗环瓜氨酸肽抗体对类风湿关节炎的诊断价值

Clinical value of rheumatoid factor and anti-cyclic citrullinated peptide antibody in the diagnosis of rheumatoid arthritis

目的探讨类风湿因子(RF)与抗环瓜氨酸肽抗体(抗-CCP抗体)联合检测对类风湿关节炎(RA)的诊断价值。方法回顾分析87例RA、34例系统性红斑狼疮(SLE)、29例混合性结缔组织病(MCTD)、21例干燥综合征(SS)患者的RF、抗-CCP抗体检测结果,RF测定采用免疫比浊法,抗-CCP抗体测定采用酶联免疫吸附试验(ELISA)。结果①RA组患者的RF和抗-CCP抗体检测结果均高于其他三组患者,差异均有统计学意义(P<0.05)。②RF诊断RA的灵敏度、特异度、阳性预测值、阴性预测值、诊断准确度分别为86.2%、72.6%、76.5%、83.6%、79.5%。③抗-CCP抗体诊断RA的灵敏度、特异度、PPV、NPV、诊断准确度分别为81.6%、85.7%、85.5%、81.8%、83.6%。④采用序列试验联合检测RF、抗-CCP抗体,此时诊断RA的灵敏度、特异度、PPV、NPV、诊断准确度分别为79.3%、94.0%、93.2%、81.4%、86.5%。结论采用序列试验联合检测RF、抗-CCP抗体可以提高RA的诊断特异度,有利于RA与其他自身免疫性疾病的鉴别诊断。

Objective To investigate the clinical value of rheumatoid factor（RF）and anti-cyclic citrullinated peptide antibody（anti-CCP antibody）in the diagnosis of rheumatoid arthritis（RA）.Methods The RF and anti-CCP antibody results of 87 cases of RA,34 cases of systemic lupus erythematosus（SLE）,29 cases of mixed connective tissue disease （MCTD）,21 cases of Sjogren＇s syndrome（SS）were analyzed retrospectively,and the RF was measured by immunotur-bidimetry,while the anti-CCP antibody was by enzyme linked immunosorbent assay（ELISA）.Results ①RF and anti-CCP antibody test results RA patients were higher than the other three groups of patients,the differences were statisti-cally significant（P 〈0.05）.②For diagnosis of RA,the RF had a sensitivity of 86.2%,specificity of 72.6%,positive predictive value（PPV）of 76.5%,negative predictive value（NPV）of 83.6%,and overall accuracy of 79.5%.③For di-agnosis of RA,the anti-CCP antibody had a sensitivity of 81.6%,specificity of 85.7%,PPV of 85.5%,NPV of 81.8%,and overall accuracy of 83.6% in the diagnosis of RA.④The RF and anti-CCP antibody by serial method had a sensitivity of 79.3%,specificity of 94.0%,PPV of 93.2%,NPV of 81.4%,and overall accuracy of 86.5% in the diag-nosis of RA.Conclusion The RF and anti-CCP antibody by serial method is able to improve the specificity in the diag-nosis of RA,so this way contributes to differential diagnosis of RA and other autoimmune diseases.