4项血清学指标联合检测在类风湿关节炎中的诊断价值

Diagnostic value of combined detection of four serum indicators in patients with rheumatoid arthritis

目的探讨抗环瓜氨酸肽抗体(抗-CCP抗体)、类风湿因子(RF)、C反应蛋白(CRP)及红细胞沉降率(ESR)联合检测在诊断类风湿关节炎(RA)的临床价值。方法回顾性分析2013年3月至2014年8月该院290例RA患者(RA组)、286例非RA的自身免疫疾病患者(非RA组)及150例体检健康者(对照组)的4项血清学指标检测结果。结果 4项血清学指标在3组间、在RA组与非RA组间、RA组与对照组间差异均有统计学意义(P=0.000);在非RA组与对照组间抗-CCP抗体差异有统计学意义(P=0.013),而其余3项指标差异无统计学意义(P>0.05)。抗-CCP抗体与RF联合检测,抗-CCP抗体、RF及CRP联合检测,抗-CCP抗体、RF及ESR联合检测,抗-CCP抗体、RF、CRP及ESR联合检测对RA诊断的灵敏度比较差异有统计学意义(P<0.05),特异度比较差异无统计学意义(P>0.05)。抗-CCP抗体、RF、CRP和ESR的受试者工作特征(ROC)曲线下面积分别为0.873、0.893、0.678和0.747。结论抗-CCP抗体和RF联合检测具有较好的特异度和灵敏度,有助于RA的临床诊断,再结合CRP和ESR的检测结果,可提高RA的检出率。

Objective To investigate the clinical value of combined detection of anti-cyclic citrullinated peptide antibody（anti-CCP antibody）,rheumatoid factor（RF）,C-reactive protein（CRP）and erythrocyte sedimentation rate（ESR）in the diagnosis of rheu-matoid arthritis（RA）.Methods The detection results of the four serum indicators of 290 cases of patients with RA（RA group）, 286 cases of patients with non-RA autoimmune diseases（non-RA group）and 1 50 cases of healthy individuals（control group）,from March 2013 to August 2014 in this hospital,were retrospectively analysed.Results The serum levels of the four indicators have significant differences among the three groups,between the RA group and non-RA group,and between the RA group and control group（P =0.000）.Between non-RA group and control group,there was significant difference of serum levels of anti-CCP antibodies （P =0.013）,while the other three serum indicators had no significant differences （P 〉 0.05）.The sensitivity of combined detection of anti-CCP antibody and RF,combined detection of anti-CCP antibody,RF and CRP,combined detection of anti-CCP antibody,RF and ESR,and combined detection of anti-CCP antibody,RF,CRP and ESR for RA diagnosis have statistically significant differences （P 〈0.05）,while there was no statistically significant differences of specificity （P 〉 0.05 ）.The area under a receiver operating characteristic （ROC） curve of anti-CCP antibody,RF,CRP and ESR were 0.873,0.893,0.678 and 0.747,respectively. Conclusion Combined detection of anti-CCP antibody and RF has good specificity and sensitivity,which could improve the clinical diagnosis of RA.Combined detection of CRP and ESR could improve the detection rate of RA.