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目的探讨联合检测血清中葡萄糖6磷酸异构酶(GPI)、抗环瓜氨酸肽抗体(抗CCP抗体)及类风湿因子(RF)对中国汉族早期类风湿关节炎(RA)的诊断价值。方法分别在116例中国汉族早期RA患者及100例健康人中对GPI、抗CCP抗体与RF进行测定。其中GPI及抗CCP抗体的检测均采用酶联免疫吸附法(ELISA),RF的检测采用免疫比浊法。早期RA诊断的金标准采用美国风湿病学会(ACR)1987年修订的RA分类标准。结果在单独检测任何一项指标时,对中国汉族早期RA诊断的敏感性由高到低依次为GPI (82.8%)、RF (81.0%)及抗CCP抗体(76.7%),特异性由高到低依次为抗CCP抗体(97%)、RF(83%)及GPI (79%);联合检测抗CCP抗体及RF这两项指标对中国汉族早期RA诊断的敏感性及特异性分别为51.7%及98%;而在联合检测GPI、抗CCP抗体与RF这三项指标时,其对中国汉族早期RA诊断的敏感性及特异性分别为49.1%及100%。和单独检测一项指标相比,联合检测抗CCP抗体及RF这两项指标及联合检测GPI、抗CCP抗体与RF这三项指标对中国汉族早期RA诊断的敏感性均有明显下降(P<0.05),但特异性均有显著提高(P<0.05)。和联合检测抗CCP抗体及RF这两项指标相比,联合检测GPI、抗CCP抗体与RF这三项指标对中国汉族早期RA诊断的敏感性有稍微降低,特异性上升到接近100%,但差异均未达统计学意义(P>0.05)。结论和仅检测单项指标相比,联合检测GPI、抗CCP抗体与RF这三项指标对中国汉族早期RA诊断的特异性显著提高到接近100%,有助于中国汉族早期RA的确诊。但和目前临床上常用的联合检测抗CCP抗体及RF这两项指标相比,联合检测GPI、抗CCP抗体与RF这三项指标对中国汉族早期RA诊断的敏感性与特异性均无明显优势。
Objective To investigate the diagnostic value of combined detection of GPI, anti-cyclic citrullinated peptide (anti-CCP) and rheumatoid factor (RF) in the early detection of rheumatoid arthritis in Chinese Han. Methods The GPI, anti-CCP antibody and RF were measured in 116 Chinese Han patients with early RA and 100 healthy controls respectively. The GPI and anti-CCP antibodies were detected by enzyme-linked immunosorbent assay (ELISA), RF detection by immunoturbidimetry. The gold standard for early diagnosis of RA uses the RA classification criteria revised by the American College of Rheumatology (ACR) in 1987. Results The sensitivity of early diagnosis of RA in Chinese Han were GPI (82.8%), RF (81.0%) and anti-CCP antibody (76.7%) from high to low, The anti-CCP antibody (97%), RF (83%) and GPI (79%) were the lowest in sequence. The sensitivity and specificity of the combined detection of anti-CCP antibody and RF were 51.7% And 98%, respectively. However, the sensitivity and specificity of the combined detection of GPI, anti-CCP antibody and RF were 49.1% and 100% respectively for early diagnosis of RA in Chinese Han. Compared with the single detection of an index, the combined detection of anti-CCP antibody and RF of these two indicators and the combined detection of GPI, anti-CCP antibody and RF of these three indicators of Chinese Han early RA diagnostic sensitivity were significantly decreased (P < 0.05), but the specificity was significantly increased (P <0.05). Compared with the combined detection of anti-CCP antibody and RF, the combined detection of GPI, anti-CCP antibody and RF showed a slight decrease in sensitivity to early diagnosis of RA in Chinese Han, and the specificity rose to nearly 100% Differences were not statistically significant (P> 0.05). Conclusions Compared with the detection of single index, the combined detection of GPI, anti-CCP antibody and RF in three indicators of Chinese Han early diagnosis of RA significantly increased the specificity of nearly 100%, contribute to the early diagnosis of RA in Chinese Han. However, compared with the two commonly used anti-CCP and anti-CCP antibodies in clinical practice, the combination of GPI, anti-CCP antibody and RF has no obvious advantage on the sensitivity and specificity of early diagnosis of RA in Chinese Han .