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目的 通过大样本研究 :①进一步了解证实抗核周因子 (APF)、抗角蛋白抗体 (AKA)在类风湿关节炎 (RA)患者中的敏感性、特异性和联合检测的意义 ,探讨早期诊断价值 ,为临床推广应用提供依据。②了解APF、AKA在非RA风湿性疾病中的分布情况 ,探讨APF、AKA在非RA风湿性疾病中阳性观察的意义 ,这些患者是否有关节损害等。方法 选取 1999年 4月至 2 0 0 3年 4月山西医科大学第二医院风湿科门诊及住院患者 190 3例 ,RA组 75 3例 ,其他风湿性疾病 115 0例。APF以人颊黏膜细胞为抗原底物 ,AKA以Wistar大鼠食管中段切片为抗原底物 ,皆用间接免疫荧光法进行检测。结果 ①在血清 1∶2 0稀释时APF对诊断RA的敏感性 39 4 6 %、特异性 96 4 1% (全部患者 )、94 72 % (剔除SpA)。②以点片状加板层状为阳性判断标准 ,AKA对诊断RA的敏感性2 5 4 4 %、特异性 95 96 % (全部患者 )、93 82 % (剔除SpA)。③与小样本比较敏感性下降 ,特异性提高 ,APF、AKA特异性明显高于类风湿因子 (RF)。④APF、AKA、RF 3种抗体联合检测时 ,1种以上任何抗体出现对RA诊断敏感性 6 9 83% ,2种以上抗体同时出现特异性 98 19% ,3种抗体同时出现特异性 99 86 %接近 10 0 %。⑤APF、AKA可出现于其他结缔组织疾病 ,这两种自身抗体在脊柱关节病?
OBJECTIVE: To further understand the sensitivity, specificity and combined detection of anti-nuclear factor (APF) and anti-keratin antibody (AKA) in patients with rheumatoid arthritis (RA) and to explore the significance of early diagnosis Value, provide the basis for clinical application. ② To understand the distribution of APF and AKA in non-RA rheumatic diseases and to explore the significance of positive observation of APF and AKA in non-RA rheumatic diseases and whether these patients have joint damage or not. Methods A total of 1903 outpatients and inpatients with rheumatology from the second hospital of Shanxi Medical University from April 1999 to April 2003 were selected, 753 patients in RA group and 115 0 other rheumatic diseases. APF to human buccal mucosal cells as antigen substrate, AKA Wistar rat middle section of the esophagus as the antigen substrate, were detected by indirect immunofluorescence. RESULTS ① The sensitivity of APF to diagnosing RA at a dilution of 1: 200 in serum was 39 4 6%, specificity was 96 4 1% (all patients), and 94 72% (excluding SpA). (2) The sensitivity of AKA to diagnosis of RA was 254.4%, the specificity was 95.96% (all patients), and 93.82% (excluding SpA). ③ Compared with the small sample, the sensitivity decreased and the specificity increased. The specificity of APF and AKA was significantly higher than that of rheumatoid factor (RF). ④ When the combination of APF, AKA and RF, the sensitivity of any one of the above antibodies to RA was 69.383%, the specificity of two or more antibodies was 98.19%, the specificity of three antibodies was 99.86% Nearly 100%. ⑤ APF, AKA can occur in other connective tissue diseases, these two autoantibodies in spondyloarthropathy?