6种血液指标在类风湿关节炎中的诊断价值

Diagnostic value of six indexes in rheumatoid arthritis

目的探讨抗环瓜氨酸多肽抗体(抗CCP抗体)、类风湿因子(RF)、C反应蛋白(CRP)、红细胞沉降率(ESR)、血红蛋白(Hb)、血小板(PLT)血液指标在类风湿关节炎(RA)中的应用价值。方法选取2015年8月至2017年9月该院95例RA患者(RA组),同时选取61例非RA的风湿病患者(非RA风湿病组)和101例健康者(健康组)。分析比较各指标在不同分组中的水平,另外比较抗CCP抗体和RF检测在RA中的诊断价值。结果 RA组的抗CCP抗体、RF、ESR、CRP、PLT水平高于健康组,且差异有统计学意义(P<0.05);Hb水平低于健康组,差异有统计学意义(P<0.05);RA组抗CCP抗体、RF、CRP、ESR、Hb、PLT水平与非RA风湿病组差异有统计学意义(P<0.05)。抗CCP抗体诊断RA的灵敏度为88.42%,特异度99.38%,阳性预测值为98.82%,阴性预测值为93.60%,阳性似然比为142.610,阴性似然比为0.117。抗CCP抗体的ROC曲线下面积为0.942;RF诊断RA的灵敏度83.16%,特异度91.98%,阳性预测值为85.87%,阴性预测值为90.30%,阳性似然比为10.37,阴性似然比为0.183。两者联合检测的灵敏度更高[90.53%(86/95)]。RF的诊断RA的受试者工作特征曲线(ROC曲线)下面积为0.911。结论抗CCP抗体、RF是RA的特异性指标,在RA的诊断中抗CCP抗体价值优于RF,CRP、ESR、Hb、PLT指标不具有特异性但可以判断的RA活动度。

Objective To discuss the value of anti-cyclic citrullinated peptide antibody （anti-CCP antibody）,rheumatoid factor （RF）,erythrocyte sedimentation rate （ESR）,C-reactive protein （CRP）,hemoglobin （Hb）,and blood platelet （PLT） in the diagnosis of rheumatoid arthritis. Methods RA group （95 cases of patients）,non-RA disease group （61 cases of patients） and normal control group （101 cases of healthy people） were randomly collected from Chaohu Hospital of Anhui Medical University in August 2015 to September 2017.The indicators were tested and compared among the groups.Meanwhile,the diagnostic value of anti-CCP antibody and RF in RA were compared and analyzed. Results The levels of anti-CCP antibody,RF,ESR,CRP and PLT in RA group were significantly higher than that of control group （ P 〈0.05）.While the level of Hb in RA group was significantly lower than that in control group （ P 〈0.05）.The levels of anti-CCP antibody,RF,CRP,ESR,Hb and PLT had significantly differences with non-RA disease group （ P 〈0.05）.The sensitivity and specificity of anti-CCP antibody in diagnosis of RA was 88.42% and 99.38%,and predicted positive value,predicted negative value,positive rate and negative rate were 98.82%,93.60%,142.610 and 0.117,and the area under the curve （AUC） was 0.942.Whereas the sensitivity,specificity,predicted positive value,predicted negative value,positive rate,negative rate and the AUC of RF were 83.16%,91.98%,85.87%, 90.30 %, 10.37 ,0.183 and 0.911.Combined detection of the two indicators had higher sensitivity [90.53%（86/95）]. Conclusion Anti-CCP antibody and RF are specific indicators of RA,and anti-CCP antibody is superior to RF in the diagnosis of RA.Indices of CRP,ESR,Hb and PLT are not specific but can be determined for RA activity.