来源：风湿病与关节炎,2017,6（12）:10-13,32.

血清GPI、抗CCP抗体、抗MCV抗体和AFA联合检测在类风湿关节炎诊断中的临床分析（临床研究）

孙　韬，王春霞，杜　凯，马艳云，唐小凤

　　【摘　要】目的：评价葡萄糖-6-磷酸异构酶（GPI）、抗环瓜氨酸肽（CCP）抗体、抗突变型瓜氨酸波形蛋白（MCV）抗体、抗聚角蛋白微丝蛋白抗体（AFA）在类风湿关节炎（RA）诊断中的意义，并比较多种指标联合检测在RA诊断中的意义。方法：对178例确诊为RA的患者进行血清学指标检测，并进行回顾性分析。血清GPI、抗CCP抗体、抗MCV抗体、AFA检测均采用酶联免疫吸附法，采用χ²检验和Pearson相关分析对多种指标在RA诊断中的价值及相关性进行比较，并对不同指标间的联合检测进行讨论分析。结果：GPI、抗CCP抗体、抗MCV抗体和AFA在RA组的特异性和灵敏度分别为65.00%和70.22%、95.00%和84.83%、78.33%和72.47%、75.71%和63.48%。RA组中GPI、抗CCP抗体、抗MCV抗体和AFA阳性率分别为70.22%、84.83%、72.47%、63.48%，显著高于对照组的11.67%、5.00%、21.67%、13.33%，差异有统计学意义（P < 0.001）；任意3种或4种指标联合检测特异性较高，但敏感度降低，明显低于单项检测抗CCP抗体，差异有统计学意义（P < 0.001）；任意3种或4种指标联合检测较单一指标检测均具有较高的阳性率，差异有统计学意义（P < 0.001），尤其是GPI + 抗CCP抗体 + 抗MCV抗体 + AFA联合检测，RA组中阳性率可达96.07%。结论：GPI、抗CCP抗体、抗MCV抗体和AFA均可作为RA诊断的血清学指标，多种血清学指标联合检测有助于提升RA诊断的阳性率。

　　【关键词】　关节炎，类风湿；葡萄糖-6-磷酸异构酶；抗环瓜氨酸肽抗体；抗突变型瓜氨酸波形蛋白抗体；抗聚角蛋白微丝蛋白抗体；类风湿因子

Clinical Analysis of the Combined Detection of Serum GPI,Anti-CCP Antibody,Anti-MCV Antibody and AFA in the Diagnosis of Rheumatoid Arthritis

SUN Tao,WANG Chun-xia,DU Kai,MA Yan-yun,TANG Xiao-feng

　　【ABSTRACT】Objective:To evaluate significance of glucose-6-phosphate isomerase（GPI）and anti-cyclic citrullinated peptide（CCP）antibody,anti-mutated citrullinated vimentin（MCV）antibody,antifilaggrin antibody（AFA）in the diagnosis of rheumatoid arthritis（RA）,and to compare the significance of combined detection of multiple indicators in RA diagnosis.Methods:The serological indexes of 178 patients with RA were examined and analyzed retrospectively.Serum GPI,anti-CCP antibody,anti-MCV antibody and AFA were detected by enzyme-linked immunosorbent assay.χ² test and Pearson correlation analysis were used to compare the value and correlation of multiple indicators in the diagnosis of RA,and the joint detection between different indicators was discussed and analyzed.Results:The specificity and sensitivity of GPI,anti-CCP antibody,anti-MCV antibody and AFA in RA group were respectively 65% and 70.22%,95% and 84.83%,78.33% and 72.47%,75.71% and 63.48%.In group RA,the positive rates of GPI,anti-CCP antibody,anti-MCV antibody and AFA were 70.22%,84.83%,72.47% and 63.48% respectively,significantly higher than those in the control group,i.e.11.67%,5%,21.67% and 13.33%,and the difference was statistically significant（P < 0.001）.Any three or four indicators combined detection had high specificity but low sensitivity,significantly lower than that of the single detection of anti-CCP antibody,and the difference was statistically significant（P < 0.001）.Any three or four indicators combined detection had a higher positive rate,and the difference was statistically significant（P < 0.001）,especially the combined detection of GPI,anti-CCP antibody,anti- MCV antibody and AFA（with a positive rate to 96.07%）.Conclusion:GPI,anti-CCP antibodies,anti-MCV antibodies and AFA can all be used as serological indicators for RA diagnosis.Combined detection of multiple serological indicators is helpful to improve the positive rate of RA diagnosis.

　　【Keywords】 arthritis,rheumatoid;glucose-6-phospho isomerase;anti-cyclic citrullinated peptide antibody;anti-mutant citrulline vimentin antibody;anti-keratin microfilament antibody;rheumatoid factor