血清多项自身抗体检测对类风湿关节炎的诊断价值  

Diagnostic Value of Serum Multiple Autoantibodies in Rheumatoid Arthritis

作　　者：冯婧 喻晓雯[2] 吴斌[2] 黄山[3] FENG Jing;YU Xiao-wen;WU Bin;HUANG Shan(Guizhou Medical University,Guiyang 550000,China;the Laboratory of TraditionalChinese Medicine to Prevent and Treat Autoimmune Disease in Chongqing,Chongqing 400000,China;Guizhou Provincial Center for Clinical Laboratory,Guiyang 550000,China)

机构地区：[1]贵州医科大学,贵阳550000 [2]重庆市中医院中医药防治自身免疫性疾病重庆市重点实验室,重庆400000 [3]贵州省临床检验中心,贵阳550000

出　　处：《现代检验医学杂志》2019年第5期9-11,15,共4页Journal of Modern Laboratory Medicine

基　　金：重庆市科技局项目基金(NO:cstc2018jxj1130084);重庆市科技局项目基金(NO:cstc2018jcyjAX0771);重庆市卫健委项目基金(NO:ZY201801009)

摘　　要：目的探讨多项自身抗体对类风湿关节炎(rheumatoid arthritis,RA)的诊断价值。方法检测150例RA组、100例非RA组和100例健康对照组的类风湿因子(rheumatoid factor,RF,包括IgA-RF,IgG-RF和IgM-RF),抗环瓜氨酸肽(cyclic citrullinated peptide,CCP)抗体,抗角蛋白抗体(anti-keratin antibodies,AKA),抗核抗体(antinuclear antibody,ANA)和抗核抗体谱(antinuclearantibody spectrum,ANAs),比较各自对RA的诊断意义。结果各指标敏感度分别为IgG-RF(19.3%),ANAs(24.0%),ANA(36.7%),AKA(50.7%),抗CCP抗体(79.3%),IgA-RF(81.3%),IgM-RF(93.3%);特异度分别为IgM-RF(55.5%),ANAs(66.0%),ANA(67.5%),IgA-RF(77.0%),IgG-RF(94.5%),抗CCP抗体(94.5%)和AKA(96.5%);各指标组间阳性率均存在差异,且差异均具有统计学意义(P<0.05)。与抗CCP抗体进行一致性分析,Kappa值分别为ANAs(-0.051),ANA(0.130),IgG-RF(0.187),IgM-RF(0.449),AKA(0.482)和IgA-RF(0.628);受试者工作特征曲线(receiver operating characteristic curve,ROC)的线下面积(area under curve,AUC)分别为IgG-RF(0.704),IgA-RF(0.870),IgM-RF(0.902)和抗CCP抗体(0.909),自身抗体联合检测,敏感度和特异度分别为96.0%和99.5%。结论IgA-RF与抗CCP抗体诊断RA高度一致,两者均是诊断RA较理想的指标,联合检测多项自身抗体能提高早期RA诊断准确度,降低漏诊率和误诊率。Objective To explore auto-antibodies for diagnosis of rheumatoid arthritis.Methods The rhe-umatoid factors(IgA-RF,IgG-RF,IgM-RF),anti-cyclic citrullinated peptide(anti-CCP)antibody,anti-keratin antibodies(AKA),anti-nuclear antibody(ANA),anti-nuclear antibody spectrum(ANAs),were detected in 150 RA groups,100 non-RA group,and 100 healthy controls group.Results The sensitivity were IgG-RF(19.3%),ANAs(24.0%),ANA(36.7%),AKA(50.7%),anti-CCP(79.3%),IgA-RF(81.3%)and IgM-RF(93.3%)respectively.The specificity were IgM-RF(55.5%),ANAs(66.0%),ANA(67.5%),IgA-RF(77.0%),IgG-RF(94.5%),anti-CCP(94.5%)and AKA(96.5%),and there were significant differences in the positive rates among the indicators,and the differences was statistically significant(P<0.05).The consistency analysis and dominance analysis of auto-antibodies and anti-CCP antibodies which the in RA group,Kappa were ANAs(-0.051),ANA(0.130),IgG-RF(0.187),IgM-RF(0.449),AKA(0.482)and IgA-RF(0.628)respectively.The ROC curve analysis showed the AUC of IgG-RF,IgA-RF,IgM-RF and anti-CCP antibodies were 0.704,0.870,0.902 and 0.909 respectively.By combing detection of various auto-antibodies,the sensitivity and specificity were 96.0%and 99.5%respectively for RA.Conclusion IgA-RF and anti-CCP antibody were highly consistent in the diagnosis of RA,both of which are ideal in dicators for the diagnosis of RA.Combined detection of multiple autoantibodies can improve the diagnostic accuracy of early RA and reduce the rate of missed diagnosis and misdiagnosis.

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

分 类 号：R593.22[医药卫生—内科学] R392.11[医药卫生—临床医学]