类风湿关节炎中酶联免疫吸附类风湿因子检测的诊断和预后特征
Diagnostic and prognostic characteristics of the enzyme linked immunosorbent rheumatoid factor assays in rheumatoid arthritis.
作者信息
Visser H, Gelinck L B, Kampfraath A H, Breedveld F C, Hazes J M
机构信息
Department of Rheumatology, University Hospital, Leiden, Netherlands.
出版信息
Ann Rheum Dis. 1996 Mar;55(3):157-61. doi: 10.1136/ard.55.3.157.
OBJECTIVE
To determine the diagnostic and prognostic test qualities of the enzyme linked immunosorbent assays (ELISA) for rheumatoid factor isotypes in rheumatoid arthritis (RA), and to compare them with the latex fixation test.
METHODS
Rheumatoid factor tests were performed in 1988 consecutive new rheumatology outpatients within two months after their first visit to the outpatient clinic of the Department of Rheumatology of Leiden University hospital. The sensitivity, specificity, accuracy, and predictive values of the tests in discriminating RA from non-rheumatoid arthritis and erosive from non-erosive disease after two years of follow up were determined and presented as receiver operating characteristic curves and post-test probability curves.
RESULTS
The sensitivity of the ELISA for IgG, IgA, and IgM rheumatoid factor for RA versus all controls at optimal cut off titres was 72%, 44%, and 69%, respectively; the specificity was 52%, 84%, and 86%. For the latex fixation test the sensitivity was 66% and the specificity 91%. The post-test probability of RA, at a clinical prevalence rate of 12%, given a positive test result in the ELISAs for IgG, IgA, and IgM rheumatoid factor and the latex fixation test, was 17%, 27%, 40%, and 49%, respectively; with negative test results the probability was 7%, 8%, 5%, and 5%, respectively. The specificity of all tests in discriminating erosive from non-erosive RA at two years was low: 41%, 44%, 47%, and 58% for the ELISAs for IgG, IgA, and IgM rheumatoid factor and the latex fixation test, respectively.
CONCLUSION
The ELISAs for IgG and IgA rheumatoid factor are of no significance in diagnosing RA and in the prediction of erosive disease. The ELISA for IgM rheumatoid factor is a reasonable alternative for the latex fixation test when age and gender are taken in to consideration. The specificity of all rheumatoid factor tests in discriminating erosive from non-erosive RA is low.
目的
确定类风湿关节炎（RA）中类风湿因子同种型的酶联免疫吸附测定（ELISA）的诊断和预后检测质量，并将其与乳胶凝集试验进行比较。
方法
对莱顿大学医院风湿病科门诊首次就诊后两个月内的1988例连续新的风湿病门诊患者进行类风湿因子检测。确定这些检测在区分RA与非类风湿关节炎以及随访两年后区分侵蚀性疾病与非侵蚀性疾病方面的敏感性、特异性、准确性和预测值，并以受试者操作特征曲线和检测后概率曲线表示。
结果
在最佳临界滴度下，ELISA检测IgG、IgA和IgM类风湿因子对RA与所有对照的敏感性分别为72%、44%和69%；特异性分别为52%、84%和86%。乳胶凝集试验的敏感性为66%，特异性为91%。在临床患病率为12%的情况下，ELISA检测IgG、IgA和IgM类风湿因子以及乳胶凝集试验检测结果为阳性时，RA的检测后概率分别为17%、27%、40%和49%；检测结果为阴性时，概率分别为7%、8%、5%和5%。所有检测在区分两年后侵蚀性RA与非侵蚀性RA方面的特异性均较低：IgG、IgA和IgM类风湿因子的ELISA以及乳胶凝集试验分别为41%、44%、47%和58%。
结论
IgG和IgA类风湿因子的ELISA在诊断RA和预测侵蚀性疾病方面无意义。考虑年龄和性别时，IgM类风湿因子的ELISA是乳胶凝集试验的合理替代方法。所有类风湿因子检测在区分侵蚀性RA与非侵蚀性RA方面的特异性均较低。
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