IgM-RF、IgG-RF、IgA-RF及抗CCP对类风湿性关节炎的诊断价值  

The diagnostic significance of IgM-RF,IgG-RF,IgA-RF and anti-CCP on rheumatoid arthritis

作　　者：蔡小慧[1] 吕星[1] 卿之驹[1] 

机构地区：[1]中南大学湘雅二医院检验科,湖南长沙410011

出　　处：《检验医学》2012年第12期1066-1069,共4页Laboratory Medicine

摘　　要：目的了解IgM、IgG、IgA 3种血清型的类风湿因子(RF)及抗环瓜氨酸肽(CCP)抗体在类风湿性关节炎(RA)诊断中的敏感性和特异性,探讨各指标及其联合检测的诊断价值。方法用酶联免疫吸附试验(ELISA)对105例RA患者、42例其他自身免疫性疾病患者和63名健康体检者的血清进行IgM-RF、IgG-RF、IgA-RF和抗CCP检测,并对结果进行统计分析。结果 RA组中IgM-RF、IgG-RF、IgA-RF及抗CCP的阳性率和浓度均显著高于其他自身免疫性疾病组和正常对照组(P均<0.01);RA组中,28个关节疾病活动度评分(DAS28)>5.1患者的IgA-RF浓度显著高于2.6<DAS28≤5.1患者(P<0.05);单独检测IgM-RF、IgG-RF、IgA-RF和抗CCP的敏感性分别为89.52%、36.19%、80.95%和76.19%,特异性分别为82.86%、95.23%、89.52%和99.05%,4项指标联合诊断的敏感性为92.38%,显著高于单独检测IgA-RF(P<0.05)、IgG-RF(P<0.01)和抗CCP(P<0.01),联合诊断的特异性为100.00%,显著高于单独检测IgM-RF和IgA-RF(P均<0.01)。结论IgM-RF、IgG-RF、IgA-RF和抗CCP对于RA均具有良好的诊断价值,4项指标联合检测可进一步提高诊断的敏感性和特异性;IgA-RF可能与疾病的活动性相关。Objective To investigate the sensitivity and specificity of IgM-rheumatoid factor （ RF）, IgG-RF, IgA- RF and anti-cyclic citrullinated peptide （CCP） antibody by respective detection and combined detection for the diagnosis of rheumatoid arthritis （RA） and their diagnosis significance. Methods A total of 105 patients with RA, 42 patients with other autoimmune diseases and 63 healthy subjects were enrolled. Serum IgM-RF, IgG-RF, IgA-RF and anti-CCP were detected by enzyme-linked immunosorbent assay （ELISA）. The results were analyzed statistically. Results The positive rates and concentrations of IgM-RF, IgG-RF, IgA-RF and anti-CCP in RA group were higher than those of other autoimmune disease group and healthy control group （ P 〈 0.01 ）. The concentrations of IgA-RF in patients with disease activity score 28 （DAS28） 〉 5.1 were higher than those with 2.6 〈 DAS28 ≤5.1 （P 〈 0.05 ）. The diagnostic sensitivities of IgM-RF, IgG-RF, IgA-RF and anti-CCP were 89. 52%, 36. 19%, 80. 95% and 76. 19%, respectively. The specificities of IgM-RF, IgG-RF, IgA-RF and anti-CCP were 82.86%, 95.23%, 89.52% and 99.05%, respectively. The sensitivity of combined detection of IgM-RF, IgG-RF, IgA-RF and anti-CCP was 92.38%, which was higher than those of IgA-RF detection （ P 〈 0. 05 ）, IgG-RF detection （ P 〈 0. 01 ） and anti-CCP detection （ P 〈 0.01 ）, and its specificity was 100. 00%, which was obviously higher than those of IgM-RF and IgA-RF detections （ P 〈 0. 01 ）. Conclusions IgM-RF, IgG-RF, IgA-RF and anti-CCP are useful indices for the diagnosis of RA, and the combined detection of IgM-RF, IgG-RF, IgA-RF and anti-CCP can improve the sensitivity and specificity of diagnosis. IgA-RF may be an index for evaluating the activity of RA.

关 键 词：类风湿因子 抗环瓜氨酸肽抗体 类风湿性关节炎 

分 类 号：R446.62[医药卫生—诊断学]