抗核周因子和抗角蛋白抗体的临床应用研究

Clinical application of antiperinuclear factor and antikeratin antibodies in rheumatoid arthritis

目的 通过大样本研究 :①进一步了解证实抗核周因子 (APF)、抗角蛋白抗体 (AKA)在类风湿关节炎 (RA)患者中的敏感性、特异性和联合检测的意义 ,探讨早期诊断价值 ,为临床推广应用提供依据。②了解APF、AKA在非RA风湿性疾病中的分布情况 ,探讨APF、AKA在非RA风湿性疾病中阳性观察的意义 ,这些患者是否有关节损害等。方法 选取 1999年 4月至 2 0 0 3年 4月山西医科大学第二医院风湿科门诊及住院患者 190 3例 ,RA组 75 3例 ,其他风湿性疾病 115 0例。APF以人颊黏膜细胞为抗原底物 ,AKA以Wistar大鼠食管中段切片为抗原底物 ,皆用间接免疫荧光法进行检测。结果 ①在血清 1∶2 0稀释时APF对诊断RA的敏感性 39 4 6 %、特异性 96 4 1% (全部患者 )、94 72 % (剔除SpA)。②以点片状加板层状为阳性判断标准 ,AKA对诊断RA的敏感性2 5 4 4 %、特异性 95 96 % (全部患者 )、93 82 % (剔除SpA)。③与小样本比较敏感性下降 ,特异性提高 ,APF、AKA特异性明显高于类风湿因子 (RF)。④APF、AKA、RF 3种抗体联合检测时 ,1种以上任何抗体出现对RA诊断敏感性 6 9 83% ,2种以上抗体同时出现特异性 98 19% ,3种抗体同时出现特异性 99 86 %接近 10 0 %。⑤APF、AKA可出现于其他结缔组织疾病 ,这两种自身抗体在脊柱关节病?

Objective To explore the value (sensitivity and specificity) of antiperinuclear factor(APF),and antikeratin antibody (AKA) for diagnosis of rheumatoid arthritis (RA),and the significance of combined use of the 3 antibodies:APF,AKA and RF(rheumatoid factor)for diagnosing early RA.Methods There were 1 903 patients with RA (n=753) and with non-RA (n=1 150).Their APF and AKA were defermined with indirect immunofluorescence technique using human buccal mucosa cells for APF and Wistar rat esophagus middle section for AKA as antigen substrates.Results Sensitivity and specificity of APF for diagnosing RA were 39.46%,95.96%(for all patients)and 94.72% (excluding SpA) at the titer 1∶20 respectively,as for AKA those were 25.44%,95.96% (for all patients) and 93.82% (excluding SpA),respectively.When the 3 antibodies were used at the same time,the overall sensitivity was 69.83% if one of them was positive,98.19% if 2 of them were positive,and 99.86% if all 3 of them were positive.When the 3 antibodies were simultanously detectable,the specifieity was 99.86% (closed to 100%).Moreover,APF and AKA were detectable in other connect tissue diseases,but rare in SpA and OA except RA.In non-RA.excluding overlap syndrome with RA,positive AKA was associated with involved wrist,proximal interphalangeal (PIP) and metacarpal-phalangeal (MIP) joints,but not other joints,Positive APF was associated with involved joints. Conclusion APF and AKA have relatively high specificity for diagnosis of RA.Simultanous detection of APF,AKA and RF can notably improve the specificity.The more the kinds of autoantibodies,the higher the specificity for diagnosis of RA.Positive AKA is associated with involvement of wrist,PIP and MIP joints.