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目的探讨类风湿因子(RF)、抗角蛋白抗体(AKA)、抗环瓜氨酸肽抗体(抗CCP)、抗核周因子(APF)联合检测对类风湿关节炎(RA)的诊断价值。方法分别抽取158例RA患者和100例对照者的血清,AKA、APF采用间接荧光法,抗CCP、RF-IgA、RF-IgG采用酶联免疫吸附法,RF-IgM采用乳胶凝集法。结果单项检测RF与联合检测RF和抗CCP抗体相比较,可使敏感度从62.6%(99/158)上升到85.4%(135/158),特异性相当;在158例RA患者中,有31.6%(50/158)患者至少出现一项抗体阳性,其中抗CCP 15.8%(25/158)、AKA 3.2%(5/158)、APF 1.9%(3/158)、RF 10.8%(17/158);而在RF阴性的55例RA患者中,61.8%(34/55)的患者至少出现一项抗体阳性,其中AKA、APF、抗CCP阳性率分别为8.9%(9/55)、5.4%(3/55)和40%(22/55)。AKA和APF两项的敏感性较低,但特异性很高。结论AKA、APF、RF和抗CCP联合检测可提高对RA的诊断,特别是对RF阴性的RA早期患者,以RF和抗CCP联合检测有更好的临床意义。
Objective To investigate the diagnostic value of rheumatoid factor (RF), anti-keratin antibody (AKA), anti-cyclic citrullinated peptide antibody (anti-CCP) and anti-nuclear factor (APF) in rheumatoid arthritis (RA) Methods Serum samples were collected from 158 patients with RA and 100 controls respectively. AKA, APF were detected by indirect fluorescence, anti-CCP, RF-IgA and RF-IgG by enzyme-linked immunosorbent assay, and RF-IgM by latex agglutination. Results Compared with the combined detection of RF and anti-CCP antibody, the single-detection RF increased the sensitivity from 62.6% (99/158) to 85.4% (135/158) with the same specificity. Among 158 RA patients, 31.6 Anti-CCP 15.8% (25/158), AKA 3.2% (5/158), APF 1.9% (3/158), RF 10.8% (17/158 ). Among the RF-negative 55 RA patients, 61.8% (34/55) had at least one positive antibody. The positive rates of AKA, APF and anti-CCP were 8.9% (9/55), 5.4% (3/55) and 40% (22/55). AKA and APF two low sensitivity, but high specificity. Conclusions The combination of AKA, APF, RF and anti-CCP can improve the diagnosis of RA, especially for patients with RF-negative early stage of RA. It is better to combine RF and anti-CCP detection.