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目的探讨抗环瓜氨酸肽(CCP)抗体、抗角蛋白抗体(AKA)及IgM型类风湿因子(IgM-RF)对早期类风湿关节炎(RA)的诊断价值。方法分析103例早期RA及259例有关节受累的非RA风湿患者的血清抗CCP抗体、AKA及IgM-RF的检测情况。分别采用ELISA方法、间接免疫荧光法及乳胶凝集法检测抗CCP抗体、AKA和IgM-RF。结果抗CCP抗体(72.8%)和IgM-RF(78.6%)对早期RA的敏感性均较AKA(36.9%)高(P均=0.0000)。抗CCP抗体、AKA和IgM-RF对早期RA的特异性分别为94.2%、90.7%及81.1%,IgM-RF较前两者低(P分别为0.0000和0.0019)。在非RA的其他弥漫性结缔组织病(DCTD)中,IgM-RF阳性率(39.1%)较AKA(17.2%)及抗CCP抗体(10.5%)高(P均<0.05)。抗CCP抗体滴定量在阳性RA患者中平均值为(85.77±58.20)RU/ml,在阳性的非RA风湿病患者中中位数为20.06RU/ml(5.2～100.6),前者显著高于后者(P<0.05)。3种抗体联合分析,抗CCP抗体+RF对RA的敏感性为61.2%,特异性为97.7%;其他组合或者敏感性较低(<33.0%),或者特异性较低(<86%)。结论3种抗体中,抗CCP抗体对早期RA的诊断价值较高。IgM-RF因特异性较低、AKA因敏感性差,对早期RA的诊断作用受到影响。3种抗体联合检测时,对其结果认真分析,可减少误诊或者漏诊。
Objective To investigate the diagnostic value of anti-cyclic citrullinated peptide (CCP) antibody, anti-keratin antibody (AKA) and IgM-type rheumatoid factor (IgM-RF) on early rheumatoid arthritis (RA). Methods The serum levels of anti-CCP, AKA and IgM-RF in 103 patients with early RA and 259 patients with non-RA rheumatoid arthritis were analyzed. Anti-CCP antibody, AKA and IgM-RF were detected by ELISA, indirect immunofluorescence and latex agglutination respectively. Results The sensitivity of anti-CCP antibody (72.8%) and IgM-RF (78.6%) to early RA was higher than that of AKA (36.9%) (P = 0.0000). The specificity of anti-CCP, AKA and IgM-RF for early RA were 94.2%, 90.7% and 81.1%, respectively. The IgM-RF was lower than the former two (P = 0.0000 and 0.0019 respectively). Among other non-RA diffuse connective tissue diseases (DCTD), the positive rate of IgM-RF (39.1%) was higher than that of AKA (17.2%) and anti-CCP antibody (10.5%) (all P <0.05). The titer of anti-CCP antibody in patients with positive RA was (85.77 ± 58.20) RU / ml, with a median of 20.06RU / ml (5.2-100.6) in patients with positive non-RA rheumatism, the former was significantly higher than the latter (P <0.05). Anti-CCP antibody + RF showed a sensitivity of 61.2% and a specificity of 97.7% for RA and lower sensitivity (<33.0%) or lower specificity (<86%) for all three antibodies. Conclusion Among the three kinds of antibodies, the anti-CCP antibody has a higher diagnostic value for early RA. The lower specificity of IgM-RF and the poor sensitivity of AKA affect the diagnostic value of early RA. When the three kinds of antibodies are tested together, their results can be carefully analyzed to reduce misdiagnosis or missed diagnosis.