评价类风湿因子与抗环瓜氨酸抗体及抗角蛋白抗体联合检测类风湿性关节炎的参考价值

摘要

目的 探讨联合检测类风湿因子(Rheumatoid Factor,RF)、抗环瓜氨酸多肽(Cyclic Citrulline Peptide,CCP)抗体及抗角蛋白抗体(Antikeratin Antibody,AKA)对于类风湿性关节炎的临床诊断价值.方法 在2014年1月至2016年9月期间本院收治的类风湿性关节炎(Rheumatoid Arthritis,RA)患者中随机选取85例,将其作为RA组,另选取同期本院收治的非RA患者105例作为非RA组,采用速率散射比浊法对两组受试对象RF进行检测,采用酶联免疫吸附法对抗CCP抗体进行检测,采用间接免疫荧光染色法对AKA进行检测,分别探讨3种指标单独检测与联合检测对RA患者的临床诊断结果.结果 在单独检测中,RF对于RA患者的诊断效能维持在70.00％左右水平,其中以AKA(93.33％)、抗CCP抗体(94.29％)单独检测对于RA的诊断特异性较高,均在90.00％以上,但上述二者对于RA的诊断敏感性(64.71％、49.41％)较低;在联合检测中,RF+抗CCP抗体+AKA联合检测对于RA的诊断敏感性最低,仅为29.41％,但3种联合检测诊断特异性高达100.00％,诊断准确性高达92.86％,明显高于RF+抗CCP抗体(74.21％)和RF+AKA(69.47％)联合检测,差异具有统计学意义(P＜0.05).结论 RF、抗CCP抗体、AKA 3种RA血清学指标在RA诊断中单独应用均存在一定局限性,通过3种指标联合应用,可有效提供RA诊断准确率,特别是在提高RA诊断特异性方面具有显著价值,可有效减少误诊或漏诊.%Objective To investigate the clinical value of the combined detection of rheumatoid factor (RF),anti-cyclic citrullinated polypeptide (CCP) antibody,and anti-keratin antibody (AKA) in the diagnosis of rheumatoid arthritis (RA).Methods 85 RA patients treated at our hospital from January 2014 to September 2016 were randomly selected as an RA group.And 105 non-RA patients treated at our hospital during the same period were selected as a non-RA group.The RF in both groups was detected by radiofrequency turbidimetric method,the Anti-CCP antibody by enzyme-linked immunosorbent assay (ELISA),and the AKA by indirect immunofluorescence staining.The diagnostic results of each or the combination of the three were analyzed.Results The diagnostic efficiency of RF for RA was about 70.00％.The diagnostic specificities of AKA and antiCCP for RA were 93.33％ and 94.29％.The diagnostic sensitivities of AKA and anti-CCP for RA were 64.71％and 49.41％.The diagnostic sensitivity of the combination of the three was 29.41％.The diagnostic specificity of the combination of the three was 100.00％.The diagnostic accuracy of the combination of the three was 92.86％,which was higher than that ofRF + anti-CCP (74.21％) and that of RF+AKA (69.47％),with statistical differences (P ＜ 0.05).Conclusions The three RA serological indicators,RF,anti-CCE and AKA,each has some limitations in the diagnosis of RA;the combination of the three can increase the diagnostic accuracy and has great value in increasing the diagnostic specificity and can effectively reduce misdiagnosis and missed diagnosis.