4种自身抗体对类风湿性关节炎的诊断价值比较

Comparison of four autoantibodies in diagnosis of rheumatoid arthritis

目的比较4种自身抗体抗核周因子(APF)、抗角蛋白抗体(AKA)、抗环瓜氨酸多肽抗体(CCP)和类风湿因子(RF)在类风湿性关节炎(RA)诊断中的价值。方法回顾2019年3至12月金华市中心医院检查的257例RA患者,采用间接免疫荧光法(IIF)检测抗APF、抗AKA,化学发光法检测抗CCP,速率散射法检测RF,计算4种自身抗体的阳性率,并采用ROC曲线分析其诊断价值。结果抗APF、抗AKA、抗CCP、RF在257例RA患者中的阳性率分别为42.80%、31.13%、79.77%、83.66%。4项联合抗APF/抗CCP/RF/抗AKA和3项联合抗APF/抗CCP/RF的阳性率均为94.16%,高于抗CCP的79.77%,差异有统计学意义(P<0.05)。抗APF与抗CCP、RF呈负相关(r=-0.470、-0.231,均P<0.05),与抗AKA、RA病程、晨僵均呈正相关(r=0.488、0.132、0.130,均P<0.05)。抗APF和抗CCP与RA关节外表现有统计学差异(P<0.05)。当抗APF最佳临界值为2.5时,AUC为0.886,灵敏度87.2%。结论抗APF在RA中有更高的灵敏度,并且抗APF与RA病程、晨僵以及关节外器官受累相关,抗APF在RA诊断中有一定的诊断价值。

Objective To compare the diagnostic value ofantiperinuclear fa c tor(APF),antikeratin antib ody(AKA),anti-cyclic citrullinated peptide antibody(CCP)and rheumatoid fa c tor(RF)in patients with rheumatoid arthritis(RA).Methods Clinical data of 257 patients with RA admitted in Jinhua Central Hospital from March to December 2019 were retrospectively reviewed.The serum levels of APF and AKA were detected with indirect immunofluorescence(IIF)assay,CCP levels were detected with chemiluminescence method,and RF levels were detected with rate scattering method.Results The positive rates of APF,AKA,CCP,RF in RA patients were 42.80%,31.13%,79.77%and 83.66%,respectively.The positive rates of combination of APF/CCP/RF/AKA and combination of APF/CCP/RF were 94.16%and 94.16%,respectively,which were higher than those of single antibody levels(P<0.05).APF was po s itively correlated with AKA(r=0.488,P<0.05)and negatively correlated with CCP and RF(r=-0.470,-0.231,both P<0.05).APF was correlated with the course of RA(r=0.132,P<0.05)and morning stiffness(r=0.130,P<0.05).APF and CCP were po s itively correlated with RA extra-articular organ involvement(P<0.05).The area under ROC curve(AUC)for APF was 0.886,taking APF=2.5 as cutoff value the sensitivity for diagnosis of RA was 87.2%.Conclusion APF has high sensitivity in diagnosis of RA.APF and CCP are complement with each other in RA diagnosis,and APF is related to the disease course,morning stiffness and extra-articular organ involvement of RA.