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血清学指标联合检测在类风湿关节炎诊断中的应用 被引量:4

Application of combined detection of serum indexes in diagnosis of rheumatoid arthritis
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摘要 目的探讨血清学指标抗环瓜氨酸肽抗体(Anti-CCP)、血清淀粉样蛋白A(SAA)、类风湿因子(RF)和C-反应蛋白(CRP)联合检测在类风湿关节炎(RA)诊断中的应用。方法选择2018年1月—2019年6月广元市中心医院收治的136例确诊RA患者作为RA组,另选择同期30例确诊为其他自身免疫性疾病患者作为非RA组,以同期30名健康体检者作为正常对照组。收集所有受检对象的血清样本,采用免疫比浊法测定SAA、RF、CRP水平,采用化学发光微粒子免疫检测法测定Anti-CCP水平;比较不同指标单独检测与联合检测对RA的诊断效能,采用Pearson相关性分析进行不同指标间的相关性分析。结果RA组Anti-CCP、SAA、RF、CRP水平均明显高于非RA组和正常对照组〔Anti-CCP(kU/L):55.40(3.90,183.15)比0.75(0.50,1.60)、0.50(0.50,1.25),SAA(mg/L):18.00(4.60,122.93)比9.40(4.73,15.73)、2.00(0.55,2.80),RF(kU/L):82.50(31.75,283.75)比17.50(14.25,25.25)、13.00(8.00,14.00),CRP(mg/L):7.25(6.48,37.98)比5.45(4.38,12.60)、0.70(0.30,1.28)〕,差异均有统计学意义(与非RA组比较,均P<0.05;与正常对照组比较,均P<0.01)。非RA组SAA、RF和CRP水平均明显高于正常对照组(均P<0.05),Anti-CCP水平与正常对照组比较差异无统计学意义(P>0.05)。4个指标联合检测RA的敏感度、准确度和阴性预测值均明显高于Anti-CCP、SAA、RF、CRP单独检测时(敏感度:97.8%比72.8%、49.3%、86.0%、56.6%,准确度:94.9%比79.1%、56.6%、84.2%、61.2%,阴性预测值:94.6%比60.2%、38.9%、71.6%、42.2%,均P<0.05);Anti-CCP单独检测的特异度和阳性预测值均明显高于SAA、RF、CRP单独检测(特异度:93.3%比73.3%、80.0%、71.7%,阳性预测值:96.1%比80.7%、90.7%、81.9%,均P<0.05)。RA组患者血清SAA与CRP水平呈中等相关性(y=1.365x+37.361,r=0.545,P=0.000),其余指标间均无相关性。结论联合检测血清Anti-CCP、SAA、RF、CRP来诊断RA可以减少误诊和漏诊,具有十分重要的临床应用价值。 Objective To investigate the application of serum indexes levels such as anti cyclic citrullinated peptide antibody(Anti-CCP),serum amyloid A(SAA),rheumatoid factor(RF)and C-reactive protein(CRP)in diagnosis of rheumatoid arthritis(RA).Methods 136 patients diagnosed with RA in Guangyuan Central Hospital from January 2018 to June 2019 were selected as RA group,the 30 patients diagnosed with other autoimmune diseases at the same period were selected as non-RA group,and other 30 healthy physical examiners at the same period were selected as normal control group.The serum samples of all subjects were collected,the levels of SAA,RF and CRP were measured by immunoturbidimetric method,and the level ofAnti-CCP was measured by chemiluminescent microparticle immunoassay.The diagnostic efficacies of different indicators alone and combined detection for RA were compared,and Pearson correlation analysis was used to analyze the correlation between different indicators.Results The serum levels of Anti-CCP,SAA,RF and CRP in RA group were significantly higher than those in non-RA group and normal control group[Anti-CCP(kU/L):55.40(3.90,183.15)vs.0.75(0.50,1.60),0.50(0.50,1.25),SAA(mg/L):18.00(4.60,122.93)vs.9.40(4.73,15.73),2.00(0.55,2.80),RF(kU/L):82.50(31.75,283.75)vs.17.50(14.25,25.25),13.00(8.00,14.00),CRP(mg/L):7.25(6.48,37.98)vs.5.45(4.38,12.60),0.70(0.30,1.28)],with significant differences(all P<0.05 compared with non-RA group and all P<0.01 compared with normal control group).The serum SAA,RF and CRP levels in non-RA group were significantly higher than those in the normal control group(all P<0.05).There was no statistical difference between the non-RA group and the normal control group in the serum Anti-CCP level(P>0.05).The sensitivity,accuracy and negative predictive value of combined detection of four indexes were higher than those of Anti-CCP,SAA,RF and CRP alone(sensitivity:97.8%vs.72.8%,49.3%,86.0%,56.6%,accuracy:94.9%vs.79.1%,56.6%,84.2%,61.2%,negative predictive value:94.6%vs.60.2%,38.9%,71.6%,42.2%,all P<0.05).The specificity and positive predictive value of Anti-CCP were higher than those of SAA,RF and CRP(specificity:93.3%vs.73.3%,80.0%,71.7%,positive predictive value:96.1%vs.80.7%,90.7%,81.9%,allP<0.05).There was a moderate correlation between SAA and CRP levels in RA group(y=1.365x+37.361,r=0.545,P=0.000),but there was no correlation among other indexes.Conclusion The combined detection of serum Anti-CCP,SAA,RF and CRP to diagnose RA can reduce incidence of misdiagnosis and missed diagnosis,which has very important clinical application value.
作者 吴义忠 李海军 蹇国 罗清松 Wu Yizhong;Li Haijun;Jian Guo;Luo Qingsong(Clinical Laboratory,Guangyuan Central Hospital,Guangyuan 628000,Sichuan,China)
出处 《实用检验医师杂志》 2021年第1期49-52,共4页 Chinese Journal of Clinical Pathologist
关键词 类风湿关节炎 抗环瓜氨酸肽抗体 血清淀粉样蛋白A 类风湿因子 C-反应蛋白 Rheumatoid arthritis Anti cyclic citrullinated peptide antibody Serum amyloid A Rheumatoid factor C-reactive protein
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