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目的:探讨抗环瓜氨酸肽抗体(anti-CCP)、抗角蛋白抗体(AKA)、类风湿因子(RF)和C反应蛋白(CRP)在类风湿关节炎(RA)早期诊断中的临床价值。方法:收集未确诊为RA的关节炎患者血清759例,检测anti-CCP和AKA,其中329例患者还同时检测RF和CRP。另取50例健康体检者作对照组,比较不同组各检测指标的差异。结果:759例关节炎患者中anti-CCP和AKA阳性者共94例(12.4%),较对照组阳性率高(P<0.05)。anti-CCP和AKA的阳性率分别为11.7%和7.9%。其中78例诊断为RA(10.3%,78/759),anti-CCP诊断阳性率达96.2%(75/78)。在329例同时行anti-CCP、AKA、RF、CRP检测的患者中,有140例出现任一项检测阳性(42.6%,140/329),明显高于对照组(P<0.01)。其中38例诊断为RA(11.6%,38/329)。4个检测项目的阳性数分别为RF 101例(30.7%)、CRP 65例(19.8%)、anti-CCP 52例(15.8%)和AKA 34例(10.3%)。RF、anti-CCP、AKA和增加CRP共有31例阳性,且均被诊断为RA。结论:各种关节炎中约10%以上可确诊为RA。在各种关节炎中4种检测指标的阳性率由高到低依次为RF、CRP、anti-CCP、AKA,其中anti-CCP对RA诊断价值较高。联合检测RF、anti-CCP、AKA和CRP(尤其是前3项)有助于提高对RA患者的早期诊断。
Objective: To investigate the clinical value of anti-CCP, AKA, RF and C-reactive protein (CRP) in the early diagnosis of rheumatoid arthritis (RA) value. METHODS: Seventy-nine patients with arthritis who were not diagnosed as RA were enrolled for anti-CCP and AKA testing, and 329 patients were also tested for RF and CRP. Another 50 cases of healthy people as a control group, comparing different groups of different test indicators. Results: There were 94 cases (12.4%) of anti-CCP and AKA positive in 759 cases of arthritis, which were higher than those in control group (P <0.05). The positive rates of anti-CCP and AKA were 11.7% and 7.9% respectively. Among them, 78 cases were diagnosed as RA (10.3%, 78/759). The positive rate of anti-CCP diagnosis was 96.2% (75/78). Of the 329 patients who underwent simultaneous anti-CCP, AKA, RF, and CRP tests, 140 showed any positive test (42.6%, 140/329), significantly higher than the control group (P <0.01). 38 of them were diagnosed as RA (11.6%, 38/329). The positive numbers of the four tests were RF 101 (30.7%), CRP 65 (19.8%), anti-CCP 52 (15.8%) and AKA 34 (10.3%). A total of 31 cases were positive for RF, anti-CCP, AKA and increased CRP, and all were diagnosed as RA. Conclusion: About 10% of all kinds of arthritis can be diagnosed as RA. Among all kinds of arthritis, the positive rates of the four kinds of indexes were RF, CRP, anti-CCP and AKA in descending order, of which anti-CCP was more valuable for the diagnosis of RA. Joint detection of RF, anti-CCP, AKA and CRP (especially the first three items) help to improve the early diagnosis of RA patients.