抗核抗体,抗CCP抗体和RF联合检查对类风湿关节炎诊断价值研究

The Value of Joint Inspection of Anti-nuclear Antibody,Anti-CCP Antibody and RF in the Diagnosis of Rheumatoid Arthritis

目的分析抗核抗体(ANA)、抗环瓜氨酸肽(CCP)抗体和类风湿因子(RF)联合检测在类风湿关节炎诊断中的临床价值。方法回顾性分析濮阳市油田总医院于2019年2月至2021年6月收治的41例类风湿关节炎患者、36例非类风湿关节炎患者的临床资料,分别纳入观察1组(类风湿关节炎患者)和观察2组(非类风湿关节炎患者);另选择同时间进行健康体检的35名体检者进行对照研究,纳入对照组;所有受检者依次测定其ANA、抗CCP抗体和RF三项指标水平,比较三组三项指标的阳性检出结果,采用受试者工作特征曲线(ROC)的线下面积(AUC)评估三项指标单独和联合检测对类风湿关节炎患者的诊断价值。结果对照组ANA检测阳性率5.71%、抗CCP抗体阳性率2.86%、RF阳性率14.29%,均低于观察2组ANA检测阳性率22.22%、抗CCP抗体检测阳性率19.44%、RF检测阳性率36.11%和观察1组ANA检测阳性率78.05%、抗CCP抗体检测阳性率85.37%、RF检测阳性率90.24%;而观察2组三项指标阳性检出率均低于观察1组(P<0.05)。观察1组联合检测三项指标显示阳性率92.68%,与三项指标单独检测的阳性率比较无明显差异(P>0.05)。经ROC曲线分析显示,ANA诊断类风湿关节炎的灵敏度75.69%、特异度70.64%、AUC为0.795,抗CCP抗体检测灵敏度76.55%、特异度80.26%、AUC为0.804,RF检测灵敏度70.36%、特异度64.28%、AUC为0.723,联合检测灵敏度89.98%、特异度92.42%、AUC为0.899;联合检测的灵敏度和特异度均高于三项指标单独检测的灵敏度和特异度(P<0.05)。结论ANA、抗CCP抗体和RF三项指标在类风湿关节炎患者中具有较高的阳性率,通过对三项指标的联合检测可以为疾病的诊断提高更加可靠的依据,诊断的灵敏度和特异度较高,临床诊断价值显著。

Objective To analyze the clinical value of the combined detection of antonuclear antibody(ANA),anti-cyclic citrullinate peptide(CCP)antibody and rheumatoid factor(RF)in the diagnosis of rheumatoid arthritis.Methods The clinical data of 41 rheumatoid arthritis patients and 36 non-rheumatoid arthritis patients admitted to Puyang Oilfield General Hospital from February 2019 to June 2021 were analysed retrospectively.Group 1(rheumatoid arthritis patients)and group 2(nonrheumatoid arthritis patients)were included respectively.In addition,a total of 35 patients who had the health examination at the same time were selected in the control group.All subjects successively measured their ANA,anti-CCP antibody and RF levels,comparing the positive detection results of three indicators between the three groups.The offline area(AUC)of the subject working characteristic curve(ROC)was used to evaluate the diagnostic value of the three indicators alone and in combination in patients with rheumatoid arthritis.Results The positive rates of ANA(5.71%),anti-CCP antibody(2.86%),and RF(14.29%)of control group were lower than those of observed group 2(22.22%,19.44%,36.11%)and observed group 1(78.05%,85.37%,90.24%);The positive detection rate of three indicators in observed 2 group was significally lower than observed 1 group(P<0.05).The positive rate of the joint detection of observe group 1 was 92.68%,and there was no significant difference with the positive rate of the three indexes alone(P>0.05).ROC curve analysis showed that the sensitivity of ANA for RA diagnosis was 75.69%,the specificity was 70.64%,and the AUC was 0.795,the sensitivity of the anti-CCP antibody detection was 76.55%,the specificity was 80.26%,and the AUC was 0.804,the sensitivity of the RF was 70.36%,the specificity was 64.28%,and the AUC was 0.723,the sensitivity of combined test was 89.98%,the specificity was 92.42%,and the AUC was 0.899.The sensitivity and specificity were higher than those of the three indexes alone(P<0.05).Conclusion ANA,anti-CCP antibody and RF have high positive rates in patients with rheumatoid arthritis.Through the combined detection of the three indicators can improve a more reliable basis for disease diagnosis,with high sensitivity and specificity,and has a significant clinical diagnostic value.