早期类风湿关节炎血清抗CCP抗体、AKA与IgM-RF检测情况分析  

Prevalence of anti-cyclic citrullinated peptide antibody,anti-keratin antibody and IgM rheumatoid factor in patients with early rheumatoid arthritis

作　　者：徐朝焰[1] 范忠晓[1] 邓琼[1] 林长艺[1] 余喜然[2] 吴美辉[2] 吴秀珍[2] 

机构地区：[1]福建医科大学附属三明第一医院风湿免疫科,三明市365000 [2]福建医科大学附属三明第一医院检验科,三明市365000

出　　处：《北京医学》2009年第11期644-647,共4页Beijing Medical Journal

基　　金：福建省三明市科技计划项目(2004-L-21)

摘　　要：目的探讨抗环瓜氨酸肽(CCP)抗体、抗角蛋白抗体(AKA)及IgM型类风湿因子(IgM-RF)对早期类风湿关节炎(RA)的诊断价值。方法分析103例早期RA及259例有关节受累的非RA风湿患者的血清抗CCP抗体、AKA及IgM-RF的检测情况。分别采用ELISA方法、间接免疫荧光法及乳胶凝集法检测抗CCP抗体、AKA和IgM-RF。结果抗CCP抗体(72.8%)和IgM-RF(78.6%)对早期RA的敏感性均较AKA(36.9%)高(P均=0.0000)。抗CCP抗体、AKA和IgM-RF对早期RA的特异性分别为94.2%、90.7%及81.1%,IgM-RF较前两者低(P分别为0.0000和0.0019)。在非RA的其他弥漫性结缔组织病(DCTD)中,IgM-RF阳性率(39.1%)较AKA(17.2%)及抗CCP抗体(10.5%)高(P均<0.05)。抗CCP抗体滴定量在阳性RA患者中平均值为(85.77±58.20)RU/ml,在阳性的非RA风湿病患者中中位数为20.06RU/ml(5.2～100.6),前者显著高于后者(P<0.05)。3种抗体联合分析,抗CCP抗体+RF对RA的敏感性为61.2%,特异性为97.7%;其他组合或者敏感性较低(<33.0%),或者特异性较低(<86%)。结论3种抗体中,抗CCP抗体对早期RA的诊断价值较高。IgM-RF因特异性较低、AKA因敏感性差,对早期RA的诊断作用受到影响。3种抗体联合检测时,对其结果认真分析,可减少误诊或者漏诊。Objective To assess the diagnostic value of anti-cyclic citrullinated peptide antibody （anti-CCP）, anti-keratin antibody （AKA）and IgM rheumatoid factor（IgM-RF） in patients with early rheumatoid arthritis（RA）. Methods This was a retrospective study on 362 patients： 103 patients with early RA （〈2 years） and 259 patients with non-RA rheumatic diseases with joint discomfort. Sera from each subject was tested for anti-CCP by enzyme linked immunosorbent assay, AKA by indirect immunofluurescence and IgM-RF by latex agglutination test. Results The sensitivity of anti-CCP （72.8%）and IgM-RF （78.6%） for early RA was better than that of AKA （36.9%）（P=0.0000）. The specificity of IgM-RF （81.1%） was lower when compared to that of anti-CCP （94.2%） or AKA （90.7%） （P=-0.0000 and 0.0019）. The average of anti-CCP titer in patients with anti-CCP （＋） RA was （85.77＋58.20）RU/ml and was higher than that in patients with anti-CCP （＋） non-RA rheumatic diseases （median 20.06RU/ml, range 5.2-100.6） （P〈0.05）. Anti-CCP combined with IgM-RF, but not others, yieled a moderate sensitivity （61.2%） but a high specificity （97.7%） when these antibodies were randomly combined to diagnose RA. The other combinations had no superiority because of their low sensitivity （〈33.0%） or poor specificity （〈86%）. Conclusions It seems that anti-CCP is an important diagnostic parameter for early RA and the value of AKA and IgM-RF for early RA is limited because of its poor sensitivity and specificity respectively. When these antibodies are combined for the diagnose of RA, a careful analysis should be taken to avoid misdiagnosis.

关 键 词：关节炎 类风湿 抗环瓜氨酸肽抗体 抗角蛋白抗体 IgM型类风湿因子 

分 类 号：R593.22[医药卫生—内科学]