血清多项自身抗体检测对类风湿关节炎的诊断价值

Diagnostic Value of Serum Multiple Autoantibodies in Rheumatoid Arthritis

目的探讨多项自身抗体对类风湿关节炎(rheumatoid arthritis,RA)的诊断价值。方法检测150例RA组、100例非RA组和100例健康对照组的类风湿因子(rheumatoid factor,RF,包括IgA-RF,IgG-RF和IgM-RF),抗环瓜氨酸肽(cyclic citrullinated peptide,CCP)抗体,抗角蛋白抗体(anti-keratin antibodies,AKA),抗核抗体(antinuclear antibody,ANA)和抗核抗体谱(antinuclearantibody spectrum,ANAs),比较各自对RA的诊断意义。结果各指标敏感度分别为IgG-RF(19.3%),ANAs(24.0%),ANA(36.7%),AKA(50.7%),抗CCP抗体(79.3%),IgA-RF(81.3%),IgM-RF(93.3%);特异度分别为IgM-RF(55.5%),ANAs(66.0%),ANA(67.5%),IgA-RF(77.0%),IgG-RF(94.5%),抗CCP抗体(94.5%)和AKA(96.5%);各指标组间阳性率均存在差异,且差异均具有统计学意义(P<0.05)。与抗CCP抗体进行一致性分析,Kappa值分别为ANAs(-0.051),ANA(0.130),IgG-RF(0.187),IgM-RF(0.449),AKA(0.482)和IgA-RF(0.628);受试者工作特征曲线(receiver operating characteristic curve,ROC)的线下面积(area under curve,AUC)分别为IgG-RF(0.704),IgA-RF(0.870),IgM-RF(0.902)和抗CCP抗体(0.909),自身抗体联合检测,敏感度和特异度分别为96.0%和99.5%。结论IgA-RF与抗CCP抗体诊断RA高度一致,两者均是诊断RA较理想的指标,联合检测多项自身抗体能提高早期RA诊断准确度,降低漏诊率和误诊率。

Objective To explore auto-antibodies for diagnosis of rheumatoid arthritis.Methods The rhe-umatoid factors(IgA-RF,IgG-RF,IgM-RF),anti-cyclic citrullinated peptide(anti-CCP)antibody,anti-keratin antibodies(AKA),anti-nuclear antibody(ANA),anti-nuclear antibody spectrum(ANAs),were detected in 150 RA groups,100 non-RA group,and 100 healthy controls group.Results The sensitivity were IgG-RF(19.3%),ANAs(24.0%),ANA(36.7%),AKA(50.7%),anti-CCP(79.3%),IgA-RF(81.3%)and IgM-RF(93.3%)respectively.The specificity were IgM-RF(55.5%),ANAs(66.0%),ANA(67.5%),IgA-RF(77.0%),IgG-RF(94.5%),anti-CCP(94.5%)and AKA(96.5%),and there were significant differences in the positive rates among the indicators,and the differences was statistically significant(P<0.05).The consistency analysis and dominance analysis of auto-antibodies and anti-CCP antibodies which the in RA group,Kappa were ANAs(-0.051),ANA(0.130),IgG-RF(0.187),IgM-RF(0.449),AKA(0.482)and IgA-RF(0.628)respectively.The ROC curve analysis showed the AUC of IgG-RF,IgA-RF,IgM-RF and anti-CCP antibodies were 0.704,0.870,0.902 and 0.909 respectively.By combing detection of various auto-antibodies,the sensitivity and specificity were 96.0%and 99.5%respectively for RA.Conclusion IgA-RF and anti-CCP antibody were highly consistent in the diagnosis of RA,both of which are ideal in dicators for the diagnosis of RA.Combined detection of multiple autoantibodies can improve the diagnostic accuracy of early RA and reduce the rate of missed diagnosis and misdiagnosis.