类风湿关节炎与骨关节炎患者血清ACCP、RF和hsCRP水平比较及其在鉴别诊断中的意义

Comparison of ACCP,RF and hsCRP Levels in Serum of Rheumatoid Arthritis and Osteoarthritis Patients and the Clinical Significance in the Differential Diagnosis

目的比较抗环瓜氨酸肽抗体(anti-cyclic citrullinated peptide,ACCP)、类风湿因子(rheumatoid factor,RF)及超敏C反应蛋白(high-sensitivity C-reactive protein,hsCRP)在类风湿关节炎(rheumatoid arthritis,RA)及骨关节炎(osteoarthritis,OA)患者血清中的含量及其在RA与OA鉴别诊断中的意义。方法选取115例类风湿关节炎患者作为RA组,74例骨关节炎患者作为OA组,健康体检者66例作为正常对照组,分别采用酶联免疫吸附法(ELISA)、透射比浊法、免疫比浊法定量检测三组患者血清中ACCP、RF及hsCRP的表达量,并对各结果进行统计分析。结果 RA组患者血清中ACCP、RF及hsCRP的含量均高于OA组(P<0.05)及对照组(P<0.05);OA组患者血清中ACCP、RF及hsCRP的含量均高于对照组(P<0.05)。指标单独检测及2种指标联合检测的阳性率在RA组高于OA组(P<0.05)和对照组(P<0.05)。单独检测时,ACCP灵敏度(78.26%)和特异度(97.14%)最高;两项指标联合检测的特异性比单独检测时增高。ACCP、RF、hsCRP、hsCRP+RF、hsCRP+ACCP和ACCP+RF对RA诊断的ROC曲线下面积分别为:0.928、0.866、0.784、0.886、0.949和0.930。结论 ACCP、RF及hsCRP在RA血清中高表达;3项指标单独检测或者两项指标联合检测对RA均有较高诊断效能;联合检测可以提高RA检测的特异度,降低误诊率,可作为临床上鉴别RA及OA的有效参考指标。

Objective To compare the levels of anti-cyclic citrullinated peptide （ACCP）, rheumatoid factor （RF） and high-sensitivity C-reactive protein （hsCRP） in serum of rheumatoid arthritis and osteoarthritis patients, and to evaluate the signification in differential diagnosis. Methods Blood samples of 115 patients with RA, 74 patients with OA and 66 normal people were collected. Enzyme-linked immunosorbent （ELISA）, transmission turbidimetry and immune turbidimetry were used to detect the serum levels of ACCP, RF and hsCRP in three groups respectively. Statistical analysis were performed according to the results above. Results The serum levels of ACCP, RF and hsCRP in RA group were signifcantly higher than those in the OA group（P〈0.05） and normal group（P〈0.05）. The concertrations of ACCP, RF and hsCRP in OA group were signifcantly higher than those in the normal group （P〈O.05）. The positive rate with the method of separate detection and combination with 2 index of RA group was signifcantly higher than those of the OA group and normal control group （P〈0.05）. The sensitivity（78.26% ） and specificity（97.14% ） of ACCP were highest with the method of separate detection （P〈0.05）. While the specificity of combination with 2 index increased significantlyly, compared with the separate detection. The areas under the ROC curve of ACCP, RF, hsCRP, hsCRP＋RF, hsCRP＋ACCP and ACCP＋RF for RA diagnosis were 0.928,0.866,0.784,0.886,0.949 and 0.930, respectively. Conclusion The expression of ACCP, RF and hsCRP in sera of RA were high. The separate detections or combination with 2 index of ACCP, RF and hsCRP all had high efficiencies in RA diagnosis. Joint detection can improve the specificity of RA diagnosis, and decrease the misdiagnosis rate, which could be as clinical indicators to identify RA and OA.