抗核周因子检测方法的建立及临床意义

The Foundation of the Antiperinuclear Factor's Detection and Clinical Significance

目的 分析抗核周因子(APF)对类风湿关节炎(RA)尤其是对早期RA诊断价值,同时探讨选择APF底物的规律性。方法 首先从152例供体中就其性别、有无结缔组织病分别进行分析,筛选出适宜做底物的个体后制备抗原片,分别对早期RA、典型RA、非RA的结缔组织病、正常对照共4组进行检测;同时检测抗角质蛋白抗体(AKA)、类风湿因子(RF)。结果 76例健康供体中女性42例,适宜作底物的23例;男性34例,适宜作底物的15例;另76例供体中有结缔组织病者39例,适宜作底物的22例;健康供体37例,适宜作底物的17例;性别和有无结缔组织病对底物的结果均无影响。以1:20为阳性阈值,APF的阳性率在4检验组中分别为:早期RA73.3％;典型RA63.3％;非RA的结缔组织病组3.3％;正常对照组3.3％。早期RA和典型RA比非RA的结缔组织病和正常对照组明显增高;APF、AKA与RF三种指标在检测中的敏感性分别为68.33％,48.33％,55.00％;特异性分别为96.67％,95.00％,91.66％。若同时检测两种自身抗体,则敏感性53.3％,特异性提高为98.33％。结论 选取底物时应适当用力深刮,涂片时应快速充分干燥。APF对于RA的诊断尤其是早期诊断有很大的价值。

Objective To analyze the diagnostic value of APF in RA especially in the early RA and discuss the regularity of substrate's antigen. Methods Analyzed 152 donors by sex and rheumatic diseases,proper donors were chosen for making antigenic plates and APF was measured in four groups : typical RA. atypical RA, miscellaneous rheumatic diseases and healthy individuals. Results There were 42 females and 34 males in 76 healthy donors and the number of proper substrate was 23 in female and 15 in male.no significant between sex. There were 39 with rheumatic diseases and 34 healthy donors in another 76 donors,the number of proper substrate was 22 in rheumatic patients and 15 in healthy donors, no significant between them. At the titer of 1 : 20,the position rate of APE was 73. 3% in atypical RA,63. 3% in typical RA,3. 3% in miscellaneous rheumatic diseases and in healthy individuals. The position rate in RA was significantly higher than other groups. Their specificity was APF(96. 67%) ,RF(91. 66%) and AKA(95. 00%) ;their sensitivity was APFC68. 33%) ,RF (55. 00%)and AKA(48. 33%). Detected two auto-antibodies at the same time,then the sensitivity became 53.33% .but the specificity raised to 98. 33%. Conclusion To make substrate with proper strength ,dried the plate quickly and fully. APF is a valuable marker for RA especially for the early RA.