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目的:探讨抗环瓜氨酸(CCP)抗体、抗角蛋白(AKA)抗体、抗核周因子(APF)和RA33抗体在老年起病类风湿关节炎(EORA)诊断和鉴别诊断中的临床意义。方法:对95例EORA(EORA组)、69例风湿性多肌痛(PMR)患者(PMR组)和47例健康者(对照组)进行抗CCP抗体、AKA、APF和RA33抗体检测,其中抗CCP抗体和RA33抗体采用酶联免疫吸附法(ELISA法)检测,AKA和APF采用间接免疫荧光法(ⅡF)法检测。结果:①抗CCP抗体、AKA、APF和RA33抗体在EORA组的敏感性和特异性分别为(58.9%、95.8%)、(33.7%、91.4%)、(31.6%、89.4%)和(36.8%、86.7%),显著高于PMR组和对照组(P<0.01)。②EORA组抗CCP抗体的敏感性显著高于AKA、APF和RA33抗体(P<0.05)。联合检测4种抗体,敏感性有所降低,但使阳性率提高至98.9%,且有更高的阳性预测值。③69例PMR患者中有6例患者CCP抗体阳性,3例AKA阳性,且与CCP抗体相重叠,2例APF阳性,2例RA33阳性,1年后3例重叠阳性的PMR患者确诊为EORA。结论:PMR与EORA有相似的临床症状和特征,临床上有时难以鉴别,极少数病例,在早期不典型时易误诊,但抗CCP抗体、AKA、APF和RA33抗体仍主要出现在EORA患者中,尤其抗CCP抗体有较高的敏感性和特异性,4种抗体联合检测有更高的特异性和阳性预测值,同时结合临床症状、影像学改变等,4种抗体联合检测对EORA的诊断和鉴别诊断有很高的临床应用价值。
Objective: To investigate the clinical significance of anti-cyclic citrullinated amino acid (CCP) antibody, anti-keratin antibody (AKA), anti-nuclear factor (APF) and RA33 antibody in the diagnosis and differential diagnosis of senile onset rheumatoid arthritis . Methods: The anti-CCP, AKA, APF and RA33 antibodies were detected in 95 patients with EORA (EORA group), 69 patients with PMR (PMR group) and 47 healthy controls (control group) CCP antibody and RA33 antibody were detected by enzyme-linked immunosorbent assay (ELISA), AKA and APF by indirect immunofluorescence (IIF) method. RESULTS: ① The sensitivity and specificity of anti-CCP, AKA, APF and RA33 antibodies in EORA group were (58.9%, 95.8%), (33.7%, 91.4%), (31.6%, 89.4%) and %, 86.7%), which was significantly higher than that of PMR group and control group (P <0.01). ② The sensitivity of anti-CCP antibody in EORA group was significantly higher than that of AKA, APF and RA33 antibody (P <0.05). Combined detection of four antibodies decreased the sensitivity, but increased the positive rate to 98.9% with a higher positive predictive value. Among the 69 PMR patients, 6 were positive for CCP antibody, 3 were AKA positive and overlapped with CCP antibody, 2 were APF positive and 2 were RA33 positive. Three patients with overlapping positive PMR were confirmed as EORA one year later. Conclusions: PMR and EORA have similar clinical symptoms and features, which are sometimes difficult to identify clinically. A very small number of cases are easily misdiagnosed in early atypical cases. Anti-CCP, AKA, APF and RA33 antibodies are still mainly found in EORA patients. Especially anti-CCP antibody has a higher sensitivity and specificity, the four antibodies combined detection of higher specificity and positive predictive value, combined with clinical symptoms, imaging changes, the four antibodies combined detection of EORA diagnosis and Differential diagnosis has a high clinical value.