类风湿关节炎患者检测血清14-3-3η蛋白和自身抗体的临床意义

Clinical significance of serum 14-3-3η protein and auto-antibodies detection in rheumatoid arthritis

目的:探讨血清14-3-3η蛋白与自身抗体检测对类风湿关节炎(RA)诊断的临床价值。方法:收集134例RA患者、90例非RA关节病变患者及同期40例健康体检者血清样本,采用ELISA和速率比浊法分别检测14-3-3η蛋白、抗CCP抗体(anti-CCP)、抗RA33抗体(anti-RA33)、抗Sa抗体(anti-Sa)和类风湿因子(RF)含量,并分析其对RA的诊断价值。结果:(1)血清14-3-3η蛋白、anti-CCP、anti-RA33、anti-Sa、RF水平在RA组均显著高于非RA组和对照组,组间差异都具有统计学意义;(2)绘制各指标ROC曲线,14-3-3η蛋白、anti-CCP、anti-RA33、anti-Sa、RF曲线下面积(AUC)分别0.831、0.852、0.615、0.706和0.739,均P<0.01;其中14-3-3η蛋白和anti-CCP达到中等以上诊断价值,对应cutoff值分别为2.59 ng/ml和24.10 U/ml;(3)所有指标中anti-Sa特异度最强为97.69%,RF灵敏度最高为83.58%;14-3-3η诊断RA的特异度为91.54%仅稍次于anti-Sa和anti-RA33抗体,但其敏感度较anti-Sa和anti-RA33均高。结论:14-3-3η蛋白、anti-CCP、anti-RA33、anti-Sa和RF在RA中均显著升高,对RA的诊断都有一定的价值。同时,14-3-3η诊断RA的敏感度和特异度相比自身抗体更有一定优势,可以作为辅助诊断RA的指标。

Objective：To explore the clinical value of detecting serum 14-3-3η and auto-antibodies in rheumatoid arthritis（RA）,and compare their performance in RA diagnosis.Methods：Serum samples of 134 RA patients,90 non-RA inflammatory arthropathy patients,70 of whom with osteoarthritis（OA） and 20 with ankylosing spondylitis（AS）,and 40 healthy controls from the second affiliated hospital of Nanchang University were collected.Concentrations of 14-3-3η,anti-CCP,anti-RA33,anti-Sa were detected with enzyme linked immunosorbent assay（ELISA）,with RF detected by immunonephelometry.Diagnostic utilities of them for RA were evaluated and compared then.Results：（1） Serum levels of 14-3-3η,anti-CCP,anti-RA33,anti-Sa and RF were significantly higher in patients with RA than non-RA inflammatory arthropathy patients and healthy controls,the differences between groups were statistically significant;（2） ROC curves were conducted according to the serum levels detected.The AUC of 14-3-3η,anti-CCP,anti-RA33,anti-Sa and RF were 0.831（95% CI：0.782-0.881）,0.852（95% CI：0.802-0.901）,0.615（95% CI：0.546-0.684）,0.706（95% CI：0.643-0.770） and 0.739（95% CI：0.676-0.802） respectively,with P values0.01.Among all index,only anti-CCP and 14-3-3η were of moderate diagnostic value,at the threshold of 24.10 U/ml and 2.59 ng/ml individually;（3）anti-Sa was of highest specificity and RF was of highest sensitivity among all indexes detected;the specificity of 14-3-3η was merely moderately inferior to anti-Sa and anti-RA33,but its sensitivity was superior to them both.Conclusion：Serume14-3-3η,anti-CCP,anti-RA33,anti-Sa and RF levels increased remarkably in patients with RA,and contributed to RA diagnosis.Meanwhile,14-3-3η was advantageous,to some extent,in the sensitivity and specificity over auto-antibodies,and can be utilized as a reference index in diagnosing RA.