摘要
目的比较抗环瓜氨酸肽抗体(抗CCP抗体)、抗角蛋白抗体(AKA)、类风湿因子(RF)在类风湿关节炎(RA)诊断及关节侵蚀预测中的价值,筛选RA关节侵蚀的危险因素。方法分别采用酶联免疫吸附法、间接免疫荧光法、速率散射比浊法检测抗CCP抗体、AKA、RF,比较三者单独或联合诊断RA的价值。用Larsen关节评分法将RA患者分为无(轻微)关节侵蚀组和严重关节侵蚀组,分析3种抗体在两组中的分布及与RA关节侵蚀相关的因素。结果3种抗体诊断RA的敏感性和特异性分别为:抗CCP抗体(49%,94%)、AKA(50%,93%)、RF(79%,67%);3种抗体两两组合后诊断RA的特异性增高;3种抗体在严重关节侵蚀组的检测值或阳性率高于轻微关节侵蚀组(P<0.05);抗CCP抗体阳性患者更易出现关节侵蚀(OR=6.71)。Logistic回归分析显示抗CCP抗体、AKA、C反应蛋白(CRP)、类风湿结节与RA的关节侵蚀有关,其中类风湿结节权重最大(OR=12.07)。结论抗CCP抗体在诊断RA中的价值优于AKA和RF;抗CCP抗体与AKA、RF联合使用可进一步提高诊断准确性;抗CCP抗体、AKA与RA关节侵蚀密切相关;综合评价RA关节侵蚀的多种危险因素有助于判断RA的预后。
Objective To explore the diagnostic significance of anti-cyclic citrullinated peptide （CCP） antibody （anti-CCP）, antikeratin antihody （AKA） and rheumatoid factor （RF） for predicting articular erosions in patients with rheumatoid arthritis （RA）. Methods One hundered and fifty eight RA patients were derided into 2 groups [limited radiographic damage group（Group 1） and severe radiographic damage group（Group 2）] based on the Larsen＇s score system. Enzyme linked immunosorbent assay, indirect immunofluorescence and rate naphelometry were used to measure anti-CCP, AKA and RF, respectively. Results The sensitivity and specificity of Anti-CCP, AKA and RF for detecting RA were 49% and 94%, 50% and 93%, and 79%6 and 67%, respectively. The specificity increased when any two markers were combined. The patients with severe radiographic damage had higher positive rates of these three antibodies than the patients with limited radiographic damage. Anti-CCP had the highest OR （6.71） for predicting articular erosions in RA patients. The logistic regression analysis showed a strong correlation between anti-CCP, AKA, CRP or cutaneous nodules and the severity of articular erosions. Anti-CCP had the strongest correlation with the severe radiographic damages. Conclusion Anti-CCP has advantages over the other two antibodies in diagnosing RA. However, the diagnostic accuracy can be improved when anti-CCP is combined with AKA or RF. Anti-CCP and AKA have strong correlations with severe articular erosions, which will be helpful for predicting the outcomes of RA.
出处
《四川大学学报（医学版）》
CAS
CSCD
北大核心
2009年第3期508-512,共5页
Journal of Sichuan University(Medical Sciences)
关键词
关节炎
类风湿
抗环瓜氨酸肽抗体
抗角蛋白抗体类风湿因子
Arthritis Rheumatoid Anti-cyclic citrullinated peptide antibody Antikeratin antibody Rheumatoid factor
