自身抗体联合检测在类风湿关节炎诊断中的意义  

Significance of combined detection of auto antibodies in rheumatoid arthritis

作　　者：张健媛[1] 梁铮[1] 柯培锋[1] 李强[1] 吴长有[2] 

机构地区：[1]广州中医药大学第二临床医学院检验科,510120 [2]中山大学中山医学院免疫学教研室,广州510080

出　　处：《国际检验医学杂志》2007年第8期681-683,共3页International Journal of Laboratory Medicine

摘　　要：目的：探讨类风湿关节炎（RA）患者联合检测血清相关自身抗体的临床意义。方法：采用ELISA检测抗CCP和抗RA33，间接免疫荧光法检测ANA、dsDNA、AKA，免疫印迹法检测ENA，免疫比浊法检测类风湿因子（RF）。RA组96例标本来自我院风湿专科门诊已确诊患者。非RA对照组78例，包括系统性红斑狼疮（SLE）56例、干燥综合征（SS）12例、骨关节炎（OA）10例。正常对照组50例，来自体检健康的志愿者。结果：96例RA患者中ANA、ENA、dsDNA、抗CCP、抗RA33、AKA和RF的阳性率分别为35．4％（34／96）、10．8％（10／96）、0．0％、49．6％（48／96）、28．1％（27／96）、22．6％（22／96）和69．6％（67／96）。而56例SLE患者其阳性率分别为90．3％、52．3％、45．0％、7．8％、5．6％、0．0％和26．7％。12例SS中只有ANA、ENA、CCP呈阳性，分别为62．5％、20．0％、2．4％。10例OA患者无1例阳性。50例正常对照者中仅2例ANA阳性，其余指标均为阴性。抗CCP、抗RA33、AKA和RF的敏感性显著高于其他3种抗体，差异有统计学意义（P〈0．05）。自身抗体的联合检测可提高SLE诊断的敏感性，但特异性无明显改变。结论：抗CCP、抗RA33和AKA均是RA特异性诊断指标，但三者与RF、ENA、ANA可相互补充，选择适当的自身抗体指标联合检测有助于提高RA诊断的敏感性和特异性。Objective To explore the clinical significance of combined detection of auto antibodies in diagnosis of rheumatoid arthritis （RA）. Methods 96 RA patients, 50 healthy controls and 78 other rheumatic diseases, including systemic lupus erythematosus （SLE） （n= 56）,Sjogren＇s syndrome （SS） （n=12）, ostarthritis （OA） （n=10）, were enrolled in the investigation. ELISA was applied to detecting anti-CCP and anti-RA33; indirect immunofluorescence assay （IFL） was applied to detecting ANA, dsDNA and AKA; immunoblotting was applied to detecting ENA; and immunoturbidimetry was applied to detecting RF. Results The seropositive rate of ANA, ENA, dsDNA, anti-CCP, anti- RA33, AKA and RF was 35.4% （34/96）, 10.8%（10/96）, 0.0% （0/96）, 49.6% （48/96）, 28.1% （27/96）, 22. 6% （22/96） and 69. 6% （67/96） respectively in RA group and 90. 3%, 52. 3%, 45.0%, 7.8%, 5.6%, 0.0% and 26.7% respectively in SLE group. In SS group, only ANA, ENA and anti-CCP were positive, their respective seropositive rate was 62.5%, 20.0% and 2.4%. None was positive in OA group. Only 2 cases of 50 healthy controls were ANA positive, and the other indices were all negative. The sensitivity of anti-CCP, anti-RA33, AKA and RF was much higher than that of other three anto antibodies （P〈0.05）. Combined detection of auto antibodies improved the sensitivity of RA diagnosis, but failed to enhance the specificity. Conclusion Anti-CCP, anti-RA33 and AKA are specific markers for diagnosing RA. Combined detection of suitable auto antibodies can increase the sensitivity and specificity.

关 键 词：类风湿关节炎 联合检测 自身抗体 敏感性 

分 类 号：R593.21[医药卫生—内科学]