抗环瓜氨酸肽抗体及相关自身抗体在幼年特发性关节炎中的诊断意义

目的探讨抗环瓜氨酸肽(CCP)抗体、类风湿因子(RF)、抗核周因子(APF)、抗角蛋白抗体(AKA)对幼年特发性关节炎(JIA)的诊断意义。方法分别采用酶联免疫吸附试验(ELISA)、间接免疫荧光法、胶乳凝集法检测54例JIA患者、31例非JIA对照组血清中的抗CCP抗体、RF、APF、AKA。结果 54例JIA患者抗CCP抗体、RF、APF、AKA的敏感性分别为61%、57%、37%、19%,特异性分别为97%、94%、97%、100%。4种抗体均具有很高的特异性。抗CCP抗体与RF在JIA的敏感性差异无统计学意义,但明显高于APF、AKA。抗CCP抗体与RF、AKA之间存在相关性,但并不完全重叠。4种抗体在多关节炎型JIA患者中的阳性率分别为76%、70%、48%和24%,在少关节炎型的阳性率分别为50%、50%、25%和12%,全身型、银屑病关节炎型、与附着点炎症相关的关节炎型和未定类的关节炎型患儿中无一例抗体检测阳性。结论抗CCP抗体对JIA的诊断具有较高的敏感性和特异性,与RF、APF和AKA联合检测,可互为补充,对JIA的诊断具有较高的临床应用价值。

Diagnostic significance of anti-cyclic citrullinated peptide antibody and other associated antibodies in paients with juvenile idiopathic arthritis

Objective To assess the diagnostic value of anti-CCP,RF,APF and AKA for juvenile idiopathic arthritis （JIA）.Methods Anti-CCP was determined by enzyme-linked immunosorbent assay,APF and AKA by indirect immunofluorescent assay,as well as RF by latex agglutination test,in serum samples from 54 patients with JIA and 31 patients without rheumatoid arthritis.Results The sensitivity of anti-CCP,RF,APF and AKA was 61%,57%,37% and 19% and the specificity was 97%,94%,97% and 100% for the diagnosis of JIA,respectively.The assay sensitivity of anti-CCP did not differ statistically from that of RF,but not APF or AKA.Anti-CCP was correlated with the level of RF and AKA.No significant overlap was detected.The assay positivity of anti-CCP,RF,APF and AKA was 76%,70%,48% and 24% in polyarticular JIA,and 50%,50%,25% and 12% in oligoarticular JIA,respectively.Anti-CCP,RF,APF and AKA could not be detected in patients with systemic JIA,psoriasis JIA,enthesitis-related JIA or unclassified JIA.Conclusion Anti-CCP is characterized by comparatively high assay sensitivity and specificity and could,when combined with the detection of RF,APF and AKA,yield complementary effects in patients with JIA.