免疫学指标联合检测在类风湿关节炎诊断中的应用  

Application of combined immunological tests in diagnosis of rheumatoid arthritis

作　　者：于红博[1] Yu Hongbo(Department of Clinical Laboratory,Jilin Central Hospital,Jilin 132011,Jilin,China)

机构地区：[1]吉林市中心医院检验科,吉林吉林132011

出　　处：《实用检验医师杂志》2022年第3期249-252,共4页Chinese Journal of Clinical Pathologist

摘　　要：目的探讨免疫学指标联合检测在类风湿关节炎(RA)诊断中的应用。方法选择2021年1—12月吉林市中心医院收治的84例RA患者作为RA组,另外选择同期84例非RA自身免疫疾病患者作为自身免疫疾病组。使用全自动生化分析仪,采用免疫散射比浊法检测类风湿因子(RF),采用抗体免疫球蛋白G(IgG)试剂盒检测抗环瓜氨酸肽(CCP),采用免疫荧光试剂盒检测抗角蛋白抗体。比较上述指标单独与不同组合联合检测对RA的诊断阳性率及诊断效能,分析不同指标检测结果RA患者的超敏C-反应蛋白(hs-CRP)和红细胞沉降率(ESR)水平。结果两组通过RF共检出RA阳性93例,抗CCP检出RA阳性69例,抗角蛋白抗体检出RA阳性68例。单一抗体检测中,RF的敏感度最高(89.29%);抗CCP的特异度最高(92.86%),阳性预测值最高为抗CCP(91.30%)。RA组各指标联合检测中,RF+抗CCP+抗角蛋白抗体阳性率最高(89.29%),明显高于其他指标组合联合检测(RF+抗角蛋白抗体:69.05%,RF+抗CCP:71.43%,抗角蛋白抗体+抗CCP:60.71%),差异均有统计学意义(均P<0.05)。RF、抗角蛋白抗体阳性和阴性患者的hs-CRP、ESR水平比较差异均无统计学意义;抗CCP阳性患者的hs-CRP、ESR水平均明显高于阴性患者〔hs-CRP(mg/L):25.67±5.19比16.24±4.16,ESR(mm/h):45.87±5.63比31.08±5.17,均P<0.05〕。结论RF、抗CCP及抗角蛋白抗体联合检测对RA诊断效果良好,具有推广价值。Objective To investigate the application of combined detection of immunological indicators in the diagnosis of rheumatoid arthritis(RA).Methods The 84 patients with RA admitted to Jilin Central Hospital from January to December 2021 were selected as RA group,and 84 autoimmune disease patients without RA during the same period were selected as autoimmune disease group.Automatic biochemical analyzer was used to detect rheumatoid factor(RF),immunoglobulin G(IgG)antibody kit for anti-cyclic citrullinated peptide(CCP),and immunofluorescence kit for antikeratin antibody.The diagnostic positive rate and diagnostic efficacy of the above indexes alone and different combinations for RA were compared,and the levels of hypersensitive C-reactive protein(hs-CRP)and erythrocyte sedimentation rate(ESR)in RA patients with the different detection results of indexes were analyzed.Results A total of 93 cases with RA positive were detected by RF,69 cases with RA positive were detected by anti-CCP,and 68 cases with RA positive were detected by antikeratin antibody.In single antibody detection,RF had the highest sensitivity(89.29%),the specificity of anti-CCP was the highest(92.86%),and the positive predictive value of anti-CCP was the highest(91.30%).In RA group,the positive rate of RF+anti-CCP+antikeratin antibody was the highest(89.29%),which was higher than those of other combinations(RF+antikeratin antibody:69.05%,RF+anti-CCP:71.43%,antikeratin antibody+anti-CCP:60.71%),with significant differences(all P<0.05).There were no significant differences in the levels of hs-CRP and ESR in RF and antikeratin antibody positive and negative patients.The levels of hs-CRP and ESR in anti-CCP positive patients were significantly higher than those in negative patients[hs-CRP(mg/L):25.67±5.19 vs.16.24±4.16,ESR(mm/h):45.87±5.63 vs.31.08±5.17,both P<0.05].Conclusion The combined detection of RF,anti-CCP and antikeratin antibodies is effective in the diagnosis of RA,and has the value of popularization.

关 键 词：类风湿关节炎 类风湿因子 抗环瓜氨酸肽 抗角蛋白抗体 

分 类 号：R593.22[医药卫生—内科学] R446.6[医药卫生—临床医学]