抗环瓜氨酸肽抗体与风湿四项联合检测对类风湿关节炎的诊断价值

Combined Detection Value of ACCP Antibody and Rheumatoid Four in Diagnosis of Rheumatoid Arthritis

目的探讨抗环瓜氨酸肽抗体(ACCP抗体)与风湿四项联合检测在类风湿关节炎(RA)诊断中的意义。方法选择RA患者82例,OA患者64例,健康对照64例,记录RA患者28关节肿胀数(SW28)、28压痛关节数(T28)、总体健康评定(GH),计算疾病活动评价分数(DAS28)。采用酶联免疫吸附试验(ELISA)检测ACCP抗体;免疫比浊法检测类风湿因子(RF)、C-反应蛋白(CRP)、抗链球菌溶血素O(ASO);Westergren法检测血沉(ESR),分析其在RA诊断中的价值。结果 RA组ACCP抗体、RF、ESR、CRP、ASO水平显著高于OA组和健康对照组;对RA的诊断敏感度分别为71.25%、78.75%、82.50%、63.75%、42.50%,特异度分别为93.75%、68.75%、65.63%、64.06%、84.38%。联合检测出现一项阳性80例(100%),两项阳性47例(58.75%),三项阳性39例(48.75%),四项阳性33例(41.25%),五项阳性16例(20%),检测指标增多,特异度增高。ACCP抗体、RF、CRP、ESR、ASO ROC曲线下面积分别为0.913、0.813、0.786、0.619、0.575。除ASO、SW28外,ACCP阳性组各指标检测值均高于阴性组。ACCP抗体、RF、CRP、ESR、ASO与疾病活动正相关。结论 ACCP抗体对RA诊断具有较高的敏感度和特异度;多项指标联合检测有助于RA诊断和鉴别诊断;ACCP抗体、RF、CRP、ESR、ASO与RA疾病活动有关,对治疗和预后的检测具有一定的临床意义。

Objective To investigate combined detection value of anti- cyclic citrullinated peptide antibody（ ACCP antibodies） antibody and rheumatoid four in diagnosis of rheumatoid arthritis. Methods 80 patients with RA,64 patients with OA and 64 cases of healthy controls were selected and the number of swollen joints28（ SW28）,tender joints 28（ T28） and general health assessment scores（ GH） were recorded while the evaluation of disease activity score（ DAS28） in patients with RA were calculated. ACCP was detected by ELISA and rheumatoid factor（ RF）,C- reactive protein（ CRP） and Anti- streptolysin O（ ASO） were tested by immunoturbidimetry while Erythrocyte sedimentation rate（ ESR） was monitored by Westergren method.Results The levels of ACCP antibodies,RF,ESR,CRP and ASO in RA group were significantly higher than those in OA group and the healthy control group. The sensitivity of the diagnosis for RA were 71. 25%,78. 75%,82. 50%,63. 75%,42. 50%,respectively,and the specificity of the diagnosis for RA were93. 75%,68. 75%,65. 63%,64. 06%,84. 38%,respectively. Combined detection of five indicators,there were 80 cases of one positive（ 100%）,two kinds of positive in 47 cases（ 58. 75%）,three kinds positive in 39 cases（ 48. 75%）,four kinds of positive in 33 cases（ 41. 25%）,five kinds of positive in 16 cases（ 20%）,and increased detection index,increased specificity. The curve area under ROC of ACCP antibodies,RF,CRP,ESR,ASO were 0. 913,0. 813,0. 786,0. 619,0. 575,respectively. In addition to ASO and SW28,ACCP positive group index detection values were higher than the negative group. ACCP antibodies,RF,CRP,ESR and ASO were positively correlated with disease activity. Conclusion ACCP antibody for RA diagnosis with high sensitivity and specificity; Many indicators joint detection contribute to RA diagnosis and differential diagnosis. ACCP antibodies,RF,CRP,ESR and ASO were associated with the disease activity of RA,and had a certain clinical significance to monitor treatment and prognosis.