血清3项指标联合检测在类风湿关节炎诊疗中的临床价值

摘要

目的 探讨抗环瓜氨酸肽抗体(抗CCP)、类风湿因子(RF)和超敏C反应蛋白(hs-CRP)联合检测在类风湿关节炎(RA)诊疗中的临床价值.方法 以53例RA患者、30例非RA患者和25例健康者为研究对象,检测并比较血清抗CCP、RF和hs-CRP水平和阳性率;采用四格表计算抗CCP、RF和hs-CRP不同组合结果的诊断效率.结果 RA患者血清3项指标检测水平和阳性率均显著高于非RA患者和健康者(P<0.01).RA患者血清抗CCP、RF和hs-CRP阳性率分别为84.9%、86.8%和81.1%,非RA患者血清RF和hs-CRP阳性率分别为23.3%和36.7%.3项指标单独检测对RA的诊断性能的优势依次为抗CCP、RF、hs-CRP;抗CCP和RF联合检测的敏感性、特异性和诊断符合率分别为92.5%、81.1%和87.0%;三者联合检测的敏感性、阴性预报率和诊断符合率分别为94.3%、93.3%和85.2%.结论 检测抗CCP诊断RA具有较高的敏感性和特异性,RF和hs-CRP特异性较差;抗CCP和RF联合检测可作为RA患者的筛查指标,有利于早期诊断,hs-CRP对RA病情严重程度的判断及指导治疗具有重要临床价值.%Objective To investigate the clinical value of combined detection of anti-cyclic citrullinated pep tide antibodies (anti-CC P ) , rheum atoid factor(R F ) and high-sensitivity C -reactive protein (hs-C RP ) for the diagnosis and treatm ent of rheum atoid ar-thritis(RA ) .M eihods Serum concentration and positive rate of anti-CCP , RF and hs-CRP were detected and com pared in 53 cases of patients w ith R A ,30 cases of patients w ithout R A and 25 cases of healthy controls . D iagnosis efficiency w ere calculated by m a-trix decision m ethod .Results Serum level and positive rate of the three detected indicators were significantly elevated in patients w ith R A , com pared w ith in patients w ithout R A and in healthy controls ( P<0 .01). T he positive rates of anti-CC P , R F and hs-CRP in patients with R A were 84 .9% ,86.8% and 81.1% ,respectively , while in patientw ithoutRA , the positive rates of RF and hs-CRP were 23 .3% and 36 .7% . The diagnosis efficiency of single detection of anti-CCP was the highest among all of the three in-dicators, and that of hs-CRP was the lowest. The sensitivity, specificity and accuracy of combined determination of anti-CCP and RF w ere 92 .5% , 81.1% and 87 .0% , and the sensitivity , negative prediction rate and accuracy of com bined determ ination of anti-CCP , RF and hc-CRP were 94 .3% , 93 .3% and 85 .2% .Conclusion Anti-CCP m ightbe relatively more sensitive and specific for the diagnosis of R A , com pared w ith R F and hs-C R P . C om bined detection of anti-C C P and R F could be usded for screening of pa-tients with R A , and could be hefcful for early diagnosis of RA . hs-CRP m ighthave in portant significance for judgm ent of disease severity and treatm ent in patients w ith R A .