抗含瓜氨酸肽抗体在早期类风湿关节炎诊断中的价值。
Value of antibodies to citrulline-containing peptides for diagnosing early rheumatoid arthritis.
作者信息
Saraux Alain, Berthelot Jean M, Devauchelle Valérie, Bendaoud Boutahar, Chalès Gérard, Le Henaff Catherine, Thorel Jean B, Hoang Sylvie, Jousse Sandrine, Baron Dominique, Le Goff Paul, Youinou Pierre
机构信息
Unit of Rheumatology and the Laboratory of Immunology, Hôpital de la Cavale Blanche, CHU Brest, BP 824, F-29609 Brest-Cedex, France.
出版信息
J Rheumatol. 2003 Dec;30(12):2535-9.
OBJECTIVE
To compare the diagnostic values of antiperinuclear factor (APF), antikeratin antibody (AKA), and anti-cyclic citrullinated peptides (anti-CCP) to discriminate between patients with and without rheumatoid arthritis (RA) and to determine the diagnostic value of anti-CCP used alone or with other tests.
METHODS
Two hundred and seventy patients with early arthritis underwent standardized investigations in 1995-1997. The clinical utility of APF, AKA, and anti-CCP in first-visit sera was evaluated using receiver-operating characteristic curves. Combinations of anti-CCP with other laboratory tests were assessed by multiple logistic regression.
RESULTS
Anti-CCP, APF, and AKA were not perfectly correlated with one another. Anti-CCP with 53 UI as the cutoff was 47% sensitive and 93% specific, versus 52% and 79%, and 47% and 94%, for APF and AKA, respectively. Multiple logistic regression selected anti-CCP, AKA, IgM-rheumatoid factor (RF) ELISA, and the latex test.
CONCLUSION
Rheumatologists can routinely use 2 or 3 tests for diagnosing RA (latex and/or IgM RF ELISA, and either AKA or anti-CCP ELISA) and can add a third or fourth test when the diagnosis remains in doubt.
目的
比较抗核周因子（APF）、抗角蛋白抗体（AKA）和抗环瓜氨酸肽（抗CCP）在鉴别类风湿关节炎（RA）患者与非RA患者方面的诊断价值，并确定单独使用抗CCP或与其他检测联合使用时的诊断价值。
方法
1995年至1997年，对270例早期关节炎患者进行了标准化检查。使用受试者工作特征曲线评估初诊血清中APF、AKA和抗CCP的临床效用。通过多元逻辑回归评估抗CCP与其他实验室检测的联合情况。
结果
抗CCP、APF和AKA之间并非完全相关。以53 UI为临界值时，抗CCP的敏感性为47%，特异性为93%，而APF的敏感性和特异性分别为52%和79%，AKA的敏感性和特异性分别为47%和94%。多元逻辑回归选择了抗CCP、AKA、IgM类风湿因子（RF）酶联免疫吸附测定（ELISA）和乳胶试验。
结论
风湿病学家可常规使用2种或3种检测来诊断RA（乳胶试验和/或IgM RF ELISA，以及AKA或抗CCP ELISA），当诊断仍存疑问时可增加第三种或第四种检测。
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