目的：探讨人类白细胞抗原（HLA）-DR4、抗环瓜氨酸肽（CCP）抗体和抗Sa抗体对类风湿性关节炎（RA）的临床诊断价值，为RA的发病机制研究提供临床依据。方法选择RA患者148例及体检正常者（正常对照组）50名，采用序列特异引物引导的聚合酶链反应（PCR）检测HLA-DR4，酶联免疫吸附试验（ELISA）检测抗CCP抗体、抗Sa抗体，对检测结果进行危险因素分析和联合检测分析。结果 RA组HLA-DR4、抗CCP抗体、抗Sa抗体阳性率明显高于正常对照组，此3项指标是与RA关联性较强的正关联危险因素[比值比（OR）分别为3.28、172.63、34.21]。 RA组HLA-DR4、抗CCP抗体和抗Sa抗体诊断RA的敏感性分别为45.95%、78.38%、40.54%，约登指数分别为0.35、0.78、0.41。抗CCP抗体与抗Sa抗体并联、HLA-DR4与抗CCP抗体并联、HLA-DR4与抗Sa抗体并联的约登指数分别为0.87、0.74、0.54。结论 HLA-DR4是RA的正关联危险因素，与RA的发生、发展存在一定联系，与抗CCP抗体和抗Sa抗体联合检测可提高其对RA的诊断价值。%Objective To investigate the determinations of human leucocyte antigen(HLA)-DR4,anti-cyclic citrullinated peptide(CCP) antibody and anti-Sa antibody for the diagnosis of rheumatoid arthritis(RA), and to provide a reference for clinical diagnosis.Methods A total of 148 patients with RA(RA group) and 50 healthy subjects(healthy control group) were enrolled. The levels of HLA-DR4 were determined by sequence specific primer polymerase chain reaction(PCR),and the levels of anti-CCP antibody and anti-Sa antibody were determined by enzyme-linked immunosorbent assay(ELISA). Risk factor analysis and the evaluation of combined determinations were performed.Results The positive rates of HLA-DR4, anti-CCP antibody amd anti-Sa antibody in RA group were higher than those in healthy control group, and there were positive correlations of HLA-DR4, anti-CCP antibody and anti-Sa antibody with RA [odds ratios(OR) were 3.28,172.63 and 34.21]. The sensitivities of HLA-DR4,anti-CCP antibody and anti-Sa antibody in RA group were 45.95%,78.38% and 40.54%,and Youden indices were 0.35,0.78 and 0.41,respectively. The Youden indices of the combined determinations of anti-CCP antibody with anti-Sa antibody,HLA-DR4 with anti-CCP antibody and HLA-DR4 with anti-Sa antibody were 0.87, 0.74 and 0.54.Conclusions There is a positive correlation of HLA-DR4 with the occurrence and development of RA,and the combined determination of anti-CCP antibody and anti-Sa antibody can improve the diagnosis of RA.
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