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目的研究血清中抗核周因子(APF)、抗角蛋白抗体(AKA)及抗环瓜氨酸多肽(CCP)抗体在类风湿性关节炎(RA)诊断中的意义。方法随机选择2006年1月至2009年8月于北京大学人民医院风湿免疫科住院的RA患者500例,应用酶联免疫吸附法检测抗CCP抗体,间接免疫荧光法检测APF和AKA,分析比较3种抗体在RA诊断中的敏感度及其与临床特点及免疫学指标的关系。结果 (1)500例RA患者中抗CCP、APF和AKA抗体诊断的敏感度分别为70.8%、51.8%和45.0%,其中抗CCP抗体敏感度明显优于APF和AKA(P<0.01)。(2)在146例抗CCP阴性的患者中APF的诊断敏感度高于AKA抗体,但差异无统计学意义(16.4%对8.9%,P=0.059)。(3)抗CCP抗体和APF抗体阳性RA患者的关节肿痛数、DAS28评分均明显高于抗体阴性患者(P均<0.001);AKA抗体阳性患者DAS28评分也明显高于AKA阴性患者(P=0.02);APF和AKA抗体阳性患者年龄较抗体阴性患者明显增高(P均<0.05),而抗CCP抗体与年龄无关(P=0.88)。(4)抗CCP抗体阳性患者ESR、IgA、IgM、IgG、RF-IgG、RF-IgM、RF-IgA水平均明显高于抗体阴性组(P均<0.05);与APF抗体阴性患者比较,APF抗体阳性者具有较高的红细胞沉降率(ESR)、IgA、IgG、RF-IgG、RF-IgM、RF-IgA水平(P均<0.05);AKA抗体阳性仅与RF-IgG、RF-IgA明显相关(P=0.02),而与ESR及免疫球蛋白无关(P均>0.05)。结论抗CCP抗体在RA诊断中的敏感度和与病情活动度的相关性均优于APF抗体,APF优于AKA抗体。
Objective To investigate the significance of serum anti-nuclear factor (APF), anti-keratin antibody (AKA) and anti-cyclic citrullinated peptide (CCP) antibodies in the diagnosis of rheumatoid arthritis (RA) Methods 500 RA patients admitted to Department of Rheumatology, Peking University People’s Hospital from January 2006 to August 2009 were randomly selected. Anti-CCP antibody was detected by enzyme-linked immunosorbent assay and APF and AKA were detected by indirect immunofluorescence. Sensitivity of Antibodies in Diagnosis of RA and Its Relationship with Clinical Features and Immunological Parameters. Results (1) The sensitivity of anti-CCP, APF and AKA antibody in 500 RA patients were 70.8%, 51.8% and 45.0%, respectively. The sensitivity of anti-CCP antibody was significantly better than APF and AKA (P <0.01). (2) The diagnostic sensitivity of APF in 146 anti-CCP negative patients was higher than AKA antibody, but the difference was not statistically significant (16.4% vs 8.9%, P = 0.059). (3) The joint swelling and pain scores and DAS28 scores of anti-CCP and APF-positive RA patients were significantly higher than those of negative patients (all P <0.001). The AKI antibody-positive patients also had significantly higher DAS28 score than AKA negative patients (P = 0.02). The age of APF and AKA positive patients was significantly higher than that of negative patients (all P <0.05), while the anti-CCP antibody was not related to age (P = 0.88). (4) The levels of ESR, IgA, IgM, IgG, RF-IgG, RF-IgM and RF-IgA in anti-CCP antibody positive patients were significantly higher than those in antibody negative patients (all P <0.05) The positive rate of erythrocyte sedimentation rate (ESR), IgA, IgG, RF-IgG, RF-IgM and RF-IgA were all higher in patients with positive antibody (P <0.05) (P = 0.02), but not with ESR and immunoglobulin (P> 0.05). Conclusions The sensitivity of anti-CCP antibody in RA diagnosis and the correlation with disease activity are better than that of APF antibody, and APF is better than AKA antibody.