常用血清抗体对类风湿关节炎诊断价值的探讨  

An Investigation on the Diagnostic Value of Common Serum Antibodies in Patients with Rheumatoid Arthritis

作　　者：王素宁 马福存 朱玲 柏明见[1] WANG Suning;MA Fucun;ZHU Ling;BAI Mingjian(Department of Clinical Laboratory,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院检验科,北京100049

出　　处：《标记免疫分析与临床》2024年第3期432-437,共6页Labeled Immunoassays and Clinical Medicine

基　　金：尿液细胞分子诊断北京市重点实验室开放课题(编号:2019-KF20);北京市卫生健康委员会重点学科建设项目。

摘　　要：目的探讨常用血清自身抗体抗突变型瓜氨酸波形蛋白抗体(anti-mutated citrullinated vimentin,MCV-Ab)、抗环瓜氨酸肽抗体(anti-cyclic citrullinated peptide,CCP-Ab)、IgM型类风湿因子(IgM-rheumatoid factors,RF-IgM)、IgG型类风湿因子(IgG-rheumatoid factors,RF-IgG)、抗RA33抗体(anti-rheumatoid arthritis 33 antibody,RA33)和抗角蛋白抗体(anti-keratin antibody,AKA)对类风湿关节炎(rheumatoid arthritis,RA)的诊断价值。方法研究对象分为两组:RA组(133例)和疾病对照组(234例,包括干燥综合征、系统性红斑狼疮、骨关节炎等)。采用酶联免疫法(ELISA)、化学发光法、间接免疫荧光法分别测定两组研究对象的MCV-Ab、CCP-Ab、RF-IgM、RF-IgG、RA33、AKA水平,分析比较各抗体在两组研究对象血清中的表达情况,采用ROC曲线分析各抗体对RA诊断的灵敏度和特异性以及联合检测对RA的诊断价值。结果RA患者血清中6种自身抗体的水平均显著高于疾病对照组(P<0.05),MCV-Ab、CCP-Ab、RF-IgM、RF-IgG、RA33、AKA诊断RA的曲线下面积分别为0.869、0.887、0.883、0.884、0.601、0.774,对疾病诊断的灵敏度分别为75.20%、79.70%、88.72%、87.97%、48.87%、57.14%,特异性分别是94.00%、96.58%、81.20%、83.33%、67.95%、97.84%。将6种抗体联合检测灵敏度为95.50%,特异性为90.20%,阳性预测值为84.70%,阴性预测值为97.20%。结论6种自身抗体联合检测对RA诊断的灵敏度高于单个自身抗体检测,并且联合检测对疾病的阴性预测值可达97.2%,可辅助临床对非RA患者做出排除诊断。Objective To investigate the clinical value of serum MCV-Ab,CCP-Ab,RF-IgM,RF-IgG,RA33 and AKA in patients with RA.Methods The study subjects were divided into two groups:RA group(133 cases)and disease control group(234 cases,including Sjogren syndrome,systemic lupus erythematosus,osteoarthritis,etc.).Expressions of serum MCV-Ab,CCP-Ab,RF-IgM,RF-IgG,RA33 and AKA in these two groups was detected by ELISA,chemiluminescence and indirect immunofluorescence methods.ROC curve was drawn to evaluate the sensitivity and specificity of each antibody.Results Expressions of serum MCV-Ab,CCP-Ab,RF-IgM,RF-IgG,RA33 and AKA were significantly higher in RA patients than those in the disease control group(P<0.05).The area under the curve of MCV-Ab,CCP-Ab,RF-IgM,RF-IgG,RA33 and AKA were 0.869,0.887,0.883,0.884,0.601 and 0.774,respectively.Sensitivities were 75.20%,79.70%,88.72%,87.97%,48.87%and 57.14%,while specificity were 94.00%,96.58%,81.20%,83.33%,67.95%and 97.84%,respectively.The sensitivity,specificity,positive predictive value and negative predictive value of the combined detection of the six antibodies were 95.50%,90.20%,84.70%and 97.20%,respectively.Conclusion Combination of MCV-Ab,CCP-Ab,RF-IgM,RF-IgG,RA33 and AKA is more robust in the diagnosis of RA than single antibody.The negative predictive value of the combination is 97.20%,suggesting that RA could be excluded when the result of combined serum antibodies is negative.

关 键 词：类风湿关节炎 抗突变型瓜氨酸波形蛋白抗体 抗环瓜氨酸肽抗体 ROC曲线 

分 类 号：R593.22[医药卫生—内科学]