联合检测RF、AKA、抗CCP抗体和CRP对RA的诊断价值

The role of combined application of RF,AKA,anti-CCP antibody and CRP in diagnosing rheumatoid arthritis

目的探讨联合检测类风湿因子(RF)、抗角蛋白抗体(AKA)、抗环瓜氨酸多肽(CCP)抗体和C反应蛋白(CRP)在类风湿性关节炎(RA)诊断中的价值。方法收集68例RA病人和42例非RA的自身免疫病病人血清,化学发光微粒子免疫法测抗CCP抗体,间接免疫荧光法检测AKA,免疫比浊法测RF和CRP,然后对检测结果进行计算分析。结果 RA组RF、AKA、抗CCP抗体和CRP的阳性率均明显高于非RA组,且差异具有统计学意义(P<0.01或P<0.05)。单项检测RA诊断的敏感性由高到低排序是CRP、抗CCP抗体、RF、AKA,特异性由高到低排序为AKA、抗CCP抗体、RF、CRP,四者串联联合检测提高了RA诊断的敏感性(91.2%),并联联合检测提高了特异性,甚至达到100%。结论 RF、AKA、抗CCP抗体、CRP单独检测RA都具有一定的灵敏度和特异性,但单独应用一项指标容易造成漏诊或误诊。联合检测四项指标可极大提高特异性和敏感度,有利于提高RA患者的早期诊断。

Objective To explore the clinical value of combination detection of rheumatoid factor（RF）,anti-cyclic citrullinated peptide antibody（CCP）,anti-keratin antibody（AKA）and c-reactive protein（CRP）in the diagnosing rheumatoid arthritis（RA）.Methods The serum samples of 68 RA patients and 42 other autoimmune diseases patients were collected.Anti-CCP antibody was detected by chemiluminescent microparticle immunoassay（CMIA）.AKA was measured by indirect immunofluorescence.Both RF and CRP were detected by Immune turbidimetry（ITM）.Then analyze the results.Results In RA group,positive rate of RF,Anti-CCP antibody,AKA,CRP was obviously higher than those of other autoimmune diseases patients（P〈0.01 or P〈0.05）,the difference between both groups was statistically significant.Single diagnostic sensitivity of RA from high to low ranking is CRP Anti-CCP antibody RF AKA.The diagnostic specificity of RA from high to low ranking is AKA Anti-CCP antibody RF CRP.Four series of joint detection improves the sensitivity（91.2%）of RA diagnosis,parallel combined detection can improve the specificity and even reached 100%.Conclusion The RF,AKA,Anti-CCP antibody and CRP detection alone RA has good sensitivity and specificity,but a separate application index easily missed diagnosis or misdiagnosis.Combined detection of four indexes may offer clinical benefits for diagnosis of RA and can significantly improve the specificity and sensitivity to diagnose RA.