类风湿关节炎相关实验室指标的诊断性能评价

Evaluation of diagnostic performance of clinical laboratory indexes in rheumatoid arthritis

目的分析评价类风湿关节炎(RA)患者抗环瓜氨酸抗体(Anti-CCP)、类风湿因子(RF)、C反应蛋白(CRP)、红细胞沉降率(SR)等4个实验室指标的临床诊断意义。方法采用电化学发光法定量测定Anti-CCP,免疫速率散射比浊法定量检测RF、CRP,仪器法检测SR,分别将2013年来该院就诊的90例RA患者、93例非RA患者的血清进行检测,通过ROC曲线对测定结果进行统计和综合分析评价。结果经检测,RA组与非RA组比较Anti-CCP、RF水平差异具有统计学意义(P<0.05),CRP、SR水平差异不具有统计学意义(P>0.05)。Anti-CCP、RF、CRP、SR曲线下面积(AUC)分别为94.0%、84.0%、51.7%和56.5%;Anti-CCP和RF的敏感度分别为90.0%和74.4%,特异度分别为94.6%和86.0%,Youden指数分别为84.6%和60.4%;CRP诊断敏感度仅为52.2%,SR诊断特异度仅为50.5%。结论 Anti-CCP、RF对RA具有良好的诊断价值,且Anti-CCP诊断性能优于RF;CRP和SR诊断性能差,仅可作为疾病进展辅助参考,联合检测以上指标对类风湿关节炎的诊断更具临床意义。

Objective To evaluate the clinical diagnostic significance of clinical laboratory indexes of anti-CCP,rheumatoid factor （RF）,C reactive protein（CRP）and erythrocyte sedimentation rate（SR）in rheumatoid arthritis.Methods Anti-CCP,RF and CRP were quantitatively tested in 90 patients confirmed as rheumatoid arthritis（RA）and 93 patients with non-rheumatoid arthritis（non-RA）diseases by the electrochemiluminescence immunoassay（ECLIA）,immunization rate scattering turbidimetry,etc.T test results were performed the statistical and comprehensive analysis by using the ROC curves.Results The levels of anti-CCP and RF had statistical differences between the RA group and the non-RA group（P 〈0.05 ）,while there was no statistically significant differ-ences in the levels of CRP and SR（P 〉0.05 ）.The areas under ROC curves（AUC）of anti-CCP,RF,CRP and SR were 94.0%, 84.0%,51.7% and 56.5% respectively;the sensitivity of anti-CCP and RF was 90.0% and 74.4% respectively,while the specifici-ty was 94.6% and 86% respectively;the Youden indexes were 84.6%and 60.4% respectively;the diagnostic sensitivity of CRP was only 52.2% and the diagnostic specificity of SR was only 50.5%.Conclusion Anti-CCP and RF have the good diagnostic value for RA,moreover the diagnostic performance of anti-CCP is better than RF;CRP and SR have the poor diagnostic preformance,the combination of above indexes has more clinical significance for diagnosing RA.