六种自身免疫性抗体联合检测在早期类风湿关节炎诊断中的临床意义

摘要

Objective: To investigate the clinical effect of combined detection of rheumatoid factor(RF), hidden rheumatoid factor(HRF)(including RFIgA, RFIgG, RFIgM), anti-keratin antibody (AKA), anti-cyclic citrullinated peptide (CCP) antibody in the early diagnosis of rheumatoid arthritis (RA). Methods: RF was determined by turbidimetric assay, HRF and anti-CCP antibody were determined by ELISA, AKA were determined by indirect immunofluorescence. 426 samples were selected by the study. Within the samples, 301 were RA patients (within 3 month 62 cases, within 12 month 142 cases, within 24 month 171 cases), and 125 patients were non-RA. RA was divided by 2 stages (Early stage was within 24 month, late stage was above 24 month) to compared the sensitivity and specificity of 6 kinds of auto-antibodies. Results: The specificity of AKA, anti -CCP antibody, RFIgG, RFIgM, RFIgA and RF were 97.37%, 92.24%, 90.76%, 82.20%, 77.31%, 76.71% respectively. By compared the 3 stage of 3 month , 12 month and 24 month RA ,there is no statistic difference of sensitivity(P>0.05). By combining determination, among RF negative RA patients, 22.50% (9/40) were AKA positive, 57.58% (19/33) were anti-CCP antibody positive, 55.00% (22/40) were HRF positive. Among RF negative RA patients, the probability of finding more than 1 positive auto-antibodies out of 5 was 50.00% (9/18); Within RF positive patients, the probability of finding more than 1 positive auto-antibodies out of 5 was 89.74% (70/78); Within RF and anti-CCP antibody negative patients, the probability of finding more than 1 positive autoantibodies out of 4 was 23.81% (5/21). Conclusion: The 6 kinds of autoantibody can be detected in early RA patients and have high value on early diagnosis of RA. AKA and anti-CCP antibody have high specificity for the diagnosis of RA. They present early in patients with RA.%目的:研究类风湿因子(RF)、隐性类风湿因子(HRF)(RFIgA、RFIgG、RFIgM),抗角蛋白抗体(AKA),抗环瓜氨酸肽抗体(抗CCP抗体)的联合检测对类风湿关节炎(RA)的早期诊断价值.方法:采用比浊法检测RF,采用ELISA法定量检测HRF,采用ELISA法检测抗CCP抗体,间接免疫荧光法检测AKA.回顾性分析了RA患者301例,其中3、12、24个月以内的早期RA患者分别为62、142和171例;非RA的风湿病患者125例.通过病程分期把RA分成早期(病程24个月之内)和中晚期患者(病程24个月以上),比较早期RA各因子之间的敏感性、特异性及联合检测的结果.结果:病程≤3个月分别与病程≤12个月、≤24个月各项诊断指标敏感性比较,差异无统计学意义(P>0.05).特异性由高到低依次为AKA(97.37%)、抗CCP(92.24%)、RFIgG(90.76%)、RFIgM(82.20%)、RFIgA(77.31%)、RF(76.71%).联合检测,RF(-)的RA患者,AKA阳性率达22.50%(9/40),抗CCP抗体阳性率达57.58%(19/33),HRF阳性率达55.00%(22/40),其他5项中1项以上阳性率达50.00%(9/18);RF(+)者其他5项中1项以上阳性率达89.74%(70/78);RF(-)抗CCP抗体(-)者其他4项中1项以上阳性率达23.81%(5/21).结论:6种自身抗体均可出现在早期的RA患者,联合检测对RA早期诊断有较高的价值,其中AKA、抗CCP抗体对RA有高度的特异性,且在RA早期即可出现.