滑液多种抗体检测诊断类风湿关节炎的临床价值

The diagnostic value of antibodies in synoviai fluid for rheumatoid arthritis

目的 通过检测RA患者血清及滑液中抗CCP抗体、RF、免疫球蛋白（Ig）G水平,及AKA、APF的阳性率,探讨滑液多种抗体检测在RA诊断中的价值.方法 入选RA患者30例,常规关节穿刺术抽取关节滑液,静脉采外周血,均离心后-70℃保存.所得数据经受试者工作特征曲线（ROC）分析确定滑液中各抗体诊断RA的阈值,及该阈值的灵敏度、特异度;并对血清及滑液中上述抗体水平进行比较.采用t检验、x^2检验及Pearson相关分析进行统计学分析.结果 抗CCP抗体诊断RA滑液有更高的阈值（29.00 U/ml）,灵敏度87％;特异度94％.RA患者滑液与血清中抗CCP抗体[（326±313） U/ml,（497±454） U/ml,t=-2.399,P＜0.05]、IgG[（57±39） mg/L,（173±86） mg/L,t=-7.4792,P＜0.05]、RF[（53±36） U/ml,（149±104） U/ml,t=-2.402,P＜0.05]水平差异有统计学意义.结论 RA患者滑液与血清抗CCP抗体、RF、IgG不仅存在数量的不同,同时存在质（分型）的不同.测定滑液抗CCP抗体、RF、IgG较血清学检测能提供更早的信息.

Objective To study the concentration of anti-cyclic citrullinated peptide antibody （CCP）,rheumatoid factor （RF）,immunoglobulin （Ig） in synovial fluid and serum of patients with rheumatoid arthritis （RA）,and the positive rate of anti-keratin antibodies （AKA） and anti-perinuclear factor （APF） were also measured.The aim was to explore the diagnostic value of these antibodies in synovial fluid for RA.Methods Thirty RA patients were collected,synovial fluid were withdrawn from the inflamed joints and peripheral blood were collected at the same time.Anti-CCP antibody,AKA,APF and RF were measured.The cut-off value of CCP in synovial fluid was determined through operating characteristic curve （ROC curves） analysis.The antibody levels in serum and synovial fluid were compared.Statistical analyses were performed using t test,and Pearson＇s correlation test.Results The cutoff value of CCP in RA synovial was higher,which was 29.00 U/ml,with the sensitivity of 87.00% and specificity of 94.10%.There were significant differences in the concentration among anti-CCP antibody [（326±313） U/ml,（496±454） U/ml,t=-2.399,P〈0.05],IgG [（57±39） mg/L,（173±86） mg/L,t=-7.4792,P〈0.05）,RF [（53±36） U/ml,（149±104） U/ml,t=-2.402,P〈0.05] in synovial and blood serum respectively in RA patients.Conchsion The diagnosis of RA is enhanced if anti-CCP antibodies,RF and IgG in synovial fluid are examined.They are supplementary to RA diagnosis and are helpful for clinical practice,especially for patient with very recent-onset RA.