摘要
目的:评价抗环瓜氨酸肽抗体(抗CCP抗体)和类风湿因子(IgM-RF)在类风湿性关节炎(RA)诊断中的意义及与骨侵蚀性的相关性。方法:选取类风湿性关节炎106例,其他疾病对照组273例(其中非RA的风湿性疾病132例,非风湿性疾病91例,正常人群50例)。对上述379份血清进行抗CCP抗体及IgM-RF检测,同时对106例RA患者行手足X摄片,将其按修正的Sharp评分分为有骨侵蚀组与无骨侵蚀组,并分析抗CCP抗体、IgM-RF及两者联合检测的敏感度、特异度、阳性似然比和阴性似然比及与骨侵蚀的相关性。结果:抗CCP抗体阳性者与RA骨侵蚀有相关性(P<0.01),IgM-RF阳性与骨侵蚀无相关性(P>0.05)。抗CCP抗体及IgM-RF对诊断RA的敏感度、特异度、阳性似然比和阴性似然比分别为:抗CCP抗体(66.04%,98.90%,60.09,0.34),IgM-RF(74.53%,79.49%,3.63,0.32)。抗CCP抗体与IgM-RF联合检测敏感度和特异度分别为58.49%、99.27%,阳性似然比和阴性似然比分别为83.56、0.42。提示抗CCP抗体特异度、阳性似然比明显高于IgM-RF,IgM-RF较抗CCP抗体有较高的敏感度,两者联合检测可提高诊断的特异度和阳性似然比、阴性似然比,但不能提高敏感度。结论:抗CCP抗体阳性者存在严重的骨关节破坏,IgM-RF与骨侵蚀无相关性。抗CCP抗体对RA诊断特异度高,IgM-RF特异度相对较低,两者联合检测可提高诊断的敏感度、特异度及阳性似然比、阴性似然比,但不能提高敏感度。抗CCP抗体对RA预后价值需进一步研究。
Objective： To evaluate the diagnostic values of anti- cyclic citrullinated peptide antibody （anti- CCP） and IgM rheumatoid factors （IgM- RF） in Rheumatoid Arthritis （RA）, and to examine the the correlation between them and the severity of erosion of bone in rheumatoid arthritis. Methods： serum anti - CCP antibodies were detected in 379 cases. 106 cases from patients with established RA and 273 from non - RA controls, including 223 patients with non - RA diseases and 50 healthy subjeets. IgM- RF were also assayed in all sample, and the results were compared to anti - CCP for sensitivity, specificity, positive likelihood ratio （ ＋ LR） and negative likelihood ratio （ - LR）. Radiographs of hands and feet were simultaneo - nsly conducted, sharp scores also evaluated. Patients were divided into the erosive of bone group and the non - erosive group based on sharp scores.The correlation between Anti- CCP antibodies and erosion of bone was analysed. Results： The severity of bone erosion in RA was associated with positive of anti- CCP （ P 〈 0.01 ）, but not with positive of IgM - RF （ P 〉 0.05） .The sensitiviety, specificity, ＋ LR and- LR of anti - CCP were 66.04%, 98.90%, 60.09 and 0.34 respectively and those of IgM - RF were 74.53%, 79.49%, 3.63 and 0.32 respectively and those of the combinative detection of anti - CCP and IgM - RF were 58.49%, 99.27%, 83.56 and 0.42 in turn. It suggested that the specificity and ＋ LR of anti - CCP were higher than that of IgM - RF, but the sensitivity of IgM - RF was higher than that of anti - CCP. The combinative detection of anti - CCP and IgM - RF can increase the specificity, ＋ LR and - LR, but not in the sensitivity. Conclusion： The severity of erosion of bone in RA are associated with anti - CCP positive cases, and also associated with IgM- RF and there was no correlation with IgM- RF and RA erosion of bone, Anti - CCP has higher specificity （98.90 % ） than IgM - RF （ 79.49 % ） for RA. The combination use of anti - CCP antibody and IgM - RF may further increase the sensitivity and specificity. The prognostic value of anti - CCP antibodies may be explored in a follow up observation.
出处
《华西医学》
CAS
2005年第4期658-660,共3页
West China Medical Journal
关键词
关节炎
类风湿
类风湿因子
抗环瓜氨酸肽抗体
骨侵蚀
arthritis
rheumatoid
rheumatoid factors （RF）
anti- cyclic citrullinated Peptide antibody （anti-CCP）
erosion of bone
