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目的探讨类风湿因子(RF)、抗环瓜氨酸肽抗体(抗CCP)及抗角蛋白抗体(AKA)联合检测对类风湿关节炎(RA)的临床诊断价值。方法对80例RA和65例非RA的其他自身免疫病患者检测RF、RF-IgM、抗CCP及AKA 4种指标。结果自身免疫性疾病女性发病较高,以RA组为甚;RA组的RF、RF-IgM、抗CCP及AKA高于其他自身免疫性疾病组;单指标检测RA诊断的敏感性为RF>RF-IgM>AKA>抗CCP,特异性为RF-IgM>抗CCP>RF>AKA。阳性预测值为抗CCP>RF>RF-IgM、AKA,阴性预测值为RF>RF-IgM>AKA>抗CCP;以并联或串联方式联合检测均以RF、RF-IgM及抗CCP三联及RF、RF-IgM、抗CCP及AKA四联检测为佳,并联检测的敏感性分别为93%及97%,串联检测的特异性分别为98%及99%。结论 RF、RF-IgM、抗CCP及AKA 4种指标联合检测可提高对RA诊断的敏感性和特异性,对RA的早期诊断有较高价值。
Objective To investigate the clinical value of combination of rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) and anti-keratin antibody (AKA) in the diagnosis of rheumatoid arthritis (RA) Methods The RF, RF-IgM, anti-CCP and AKA were detected in 80 patients with RA and 65 patients with other non-RA autoimmune diseases. Results The incidence of autoimmune diseases in women was higher, especially in RA group. The RF, RF-IgM, anti-CCP and AKA in RA group were higher than those in other autoimmune diseases group. The sensitivity of single index in detecting RA was RF> RF -IgM> AKA> anti-CCP, specific for RF-IgM> anti-CCP> RF> AKA. The positive predictive values were anti-CCP> RF> RF-IgM and AKA. The negative predictive values were RF> RF-IgM> AKA> anti-CCP. The combined detection in parallel or in series was based on RF, RF- , RF-IgM, anti-CCP and AKA, the sensitivity of parallel detection was 93% and 97% respectively, and the specificity of tandem detection was 98% and 99% respectively. Conclusion The combined detection of 4 kinds of indexes of RF, RF-IgM, anti-CCP and AKA can improve the sensitivity and specificity of RA diagnosis. It has high value in the early diagnosis of RA.