HLA-B27、ANA和ANCA检测对类风湿性关节炎的诊断价值

Diagnostic value of HLA-B27,ANA and ANCA in rheumatoid arthritis

目的探讨人类白细胞B27抗原(HLA-B27)、抗核抗体(ANA)和抗中性粒细胞胞质抗体(ANCA)在诊断类风湿性关节炎(RA)的临床价值。方法选取2018年9月至2020年9月在我院风湿科住院的患者,其中RA组132例,并随机选取同期治疗的非RA组患者132例,比较两组一般资料和维生素D(VitD)、白细胞介素33(IL-33)、白细胞介素35(IL-35)水平;分析HLA-B27、ANA和ANCA的阳性率,相关性分析IL-33、IL-35和VitD水平与HLA-B27、ANA和ANCA阳性率的关系,判断HLA-B27、ANA和ANCA诊断RA的准确性。结果两组一般资料无显著差异(P>0.05);RA组IL-33水平高于非RA组患者(P<0.05),IL-35和VitD显著低于非RA组(P<0.05);RA组HLA-B27、ANA和ANCA阳性率均高于非RA组(P<0.05);RA组患者IL-33水平与HLA-B27(+)、ANA(+)和ANCA(+)呈正相关(r=0.356、0.321和0.290,P<0.05),IL-35水平与HLA-B27(+)、ANA(+)和ANCA(+)呈负相关(r=-0.299、-0.357和-0.301,P<0.05),VitD水平与HLA-B27(+)、ANA(+)和ANCA(+)呈负相关(r=-0.407、-0.335和-0.371,P<0.05)。HLA-B27诊断RA灵敏度、特异度和kappa系数分别为77.78%、97.36%和0.697;ANA诊断RA灵敏度、特异度、和kappa系数分别为80.56%、92.68%和0.648;ANCA诊断RA灵敏度、特异度和kappa系数值分别为79.49%、95.06%和0.715;HLA-B27、ANA和ANCA联合诊断RA灵敏度、特异度和kappa系数分别为81.82%、96.00%和0.785。结论HLA-B27、ANA和ANCA联合检测可以提高RA诊断的准确度,值得临床推广使用。

Objective To investigate the clinical value of human leukocyte B27 antigen(HLA-B27),anti-nuclear antibody(ANA)and anti-neutrophil cytoplasmic antibody(ANCA)in the diagnosis of rheumatoid arthritis(RA).Methods Patients hospitalized in the rheumatology Department of our hospital from September 2018 to September 2020 were selected,including 132 patients in the RA group,and 132 patients in the non-RA group were randomly selected during the same period.General data and levels of vitamin D(VitD),interleukin33(IL-33)and interleukin35(IL-35)were compared between the two groups.The positive rates of HLA-B27,ANA and ANCA were analyzed,and the correlation between IL-33,IL-35 and VitD levels and the positive rates of HLA-B27,ANA and ANCA was analyzed to determine the accuracy of HLA-B27,ANA and ANCA in the diagnosis of RA.Results There was no significant difference in general data between the two groups(P>0.05).IL-33 level in RA group was higher than that in non-RA group(P<0.05),IL-35 and VitD were significantly lower than that in non-RA group(P<0.05).The positive rates of HLA-B27,ANA and ANCA in RA group were higher than those in non-RA group(P<0.05).IL-33 levels in RA patients were positively correlated with HLA-B27(+),ANA(+)and ANCA(+)(r=0.356,0.321 and 0.290,P<0.05).IL-35 levels were negatively correlated with HLA-B27(+),ANA(+)and ANCA(+)(r=-0.299,-0.357 and-0.301,P<0.05).VitD levels were negatively correlated with HLA-B27(+),ANA(+)and ANCA(+)(r=--0.407,-0.335 and-0.371,P<0.05).The sensitivity,specificity and kappa coefficient of HLA-B27 in the diagnosis of RA were 77.78%,97.36%and 0.697,respectively.The sensitivity,specificity and kappa coefficient of ANA in the diagnosis of RA were 80.56%,92.68%and 0.648,respectively.The sensitivity,specificity and kappa coefficient of ANCA in the diagnosis of RA were 79.49%,95.06%and 0.715,respectively.The sensitivity,specificity and kappa coefficient of the combined diagnosis of RA by HLA-B27,ANA and ANCA were 81.82%,96.00%and 0.785,respectively.Conclusion The combination of HLA-B27,ANA and ANCA can improve the accuracy of RA diagnosis and is worthy of clinical application.