类风湿因子、抗环瓜氨酸多肽抗体和抗角蛋白抗体联合检测在类风湿关节炎诊断中的价值  

Diagnostic Values of Combined Detection of Rheumatoid Factor,Anticyclic Citrullinated Peptide Antibody and Antikeratin Antibody in Rheumatoid Arthritis

作　　者：张新刚[1] 张晓莉[1] 蒋莉[1] 郭韵[1] 王晓非[1] 

机构地区：[1]中国医科大学附属盛京医院风湿免疫内科,沈阳110004

出　　处：《中国医科大学学报》2012年第12期1130-1133,共4页Journal of China Medical University

基　　金：辽宁省医学高峰建设工程(200931);沈阳市科学技术项目计划(2012122333)

摘　　要：目的评估类风湿因子(RF)、抗环瓜氨酸多肽(CCP)抗体和抗角蛋白抗体(AKA)联合检测在类风湿关节炎(RA)诊断中的价值。方法分别应用免疫比浊法、ELISA法和间接免疫荧光染色法检测278例RA患者和510例对照者血清中的RF、抗CCP抗体和AKA水平,并分析3种抗体在RA诊断中的价值。结果单一抗体检测中敏感度以RF最高(79.86%),特异度以抗CCP抗体最高(94.51%),阳性预测值以抗CCP抗体最高(88.03%),阴性预测值以RF(87.16%)或抗CCP抗体(87.00%)(2者接近)最高,阳性似然比以抗CCP抗体最高(13.50),阴性似然比以RF(0.27)或抗CCP抗体(0.27)最低;联合检测中敏感度以RF+抗CCP抗体最高(67.63%),特异度以抗CCP抗体+AKA最高(96.27%),阳性预测值以RF+AKA最高(89.55%),阴性预测值以RF+抗CCP抗体最高(84.32%),阳性似然比以RF+AKA最高(15.72),阴性似然比以RF+抗CCP抗体最低(0.34)。结论 3项指标联合检测可显著提高RA的早期诊断率,抗CCP抗体的诊断价值高于AKA和RF,RF+抗CCP抗体联合检测最有意义和价值。Objective To evaluate the diagnostic values of confi,ined detection of rheumatoid factor （RF）,anticyclic citndlinated peptide antibody and antikeratin antibody （AKA） in rheumatoid arthritis （RA）. Methods Sera from 278 RA patients and 510 controls were ana- lyzed. RF, anticyclic citrullinated peptide antibody and AKA were detected using immune turbidimetly, EHSA and indi^et immunofluores- cenee, respectively. The distributions of these antibodies were compared to determine the diagnostic values of combined detection of RF, anti- cyclic citrullinated peptide antibody and AKA in RA patients. Results In the single antibody detection,RF had the highest sensitivity （79.86%）, antieyclic citndlinated peptide antibody had the highest specificity（94.51% ） and the highest positive predictive value（ 88.03% ）, RF（ 87.16% ） or anticyclic citrullinated peptide antibody （87%） had the highest negative predictive value, anticyclic citrullinated peptide an- tibody had the highest PLR（ 13.5 ）, RF（0.27 ） or anticyelic eitrullinated peptide antibody（0.27 ） had the lowest NLR. In the combined de- tec, tion, RF and anticyclic eitndlinated peptide antibody showeci the highest sensitivity （67.63%）, and highest specificity （96.27%） was ob- served with anticyclic eitrullinated peptide antibody and AKA;RF and AKA had the highest positive predictive value（89.55% ）,RF and an- ticyclic citrullinated peptide antibody had the highest negative predictive value （84.32%）,RF and AKA had the highest PLR（ 15.72）,RF and anticyclic citrullinated peptide antibody had the lowest NLR（0.34）. Conclusion The combined detection between the three antibodies obviously improved the earlier diagnosis of RA. The diagnostic value of anticyclic citrulinated peptide antibody was superior to AKA and RF. The combined detection ot： RF and anticyelie citrullinated peptide antibody had the most significant diagnostie value.

关 键 词：关节炎 类风湿 类风湿因子 瓜氨酸 角蛋白 抗体 

分 类 号：R593.22[医药卫生—内科学]