摘要目的 了解抗环瓜氨酸多肽(CCP)抗体在中国人群中诊断类风湿关节炎的敏感度、特异度及其对类风湿关节炎发病的预测价值.方法 收集2007年11月至2008年3月在上海长征医院进行健康体检的健康人群1018例,风湿科门诊及住院确诊类风湿关节炎患者212例,其他结缔组织病患者435例,应用酶联免疫吸附法检测其血清抗CCP抗体滴度,对健康人群及类风湿关节炎患者同时检测IgM型类风湿因子(IgM-RF).比较抗CCP抗体阳性率及滴度差异,并统计健康人群和类风湿关节炎患者中IgM-RF的阳性率,计算IgM-RF诊断类风湿关节炎的特异度.结果 (1)类风湿关节炎患者血清抗CCP抗体阳性率为48.1%(102例),明显高于健康人群(2.6%,26例)和其他结缔组织病患者(3.7%,16例),其诊断类风湿关节炎的特异度高达97.4%.(2)类风湿关节炎患者抗CCP抗体滴度为429.7 U,明显高于健康人群(29.3 U)和其他结缔组织病患者(36.5 U).(3)IgM-RF在类风湿关节炎患者中的阳性率为94.3%,而在健康人群中的阳性率为21.5%.抗CCP抗体的假阳性率(2%)显著低于IgM-RF(21.5%,P＜0.01).结论 抗CCP抗体在类风湿关节炎诊断中具有高度的特异度,且类风湿关节炎患者血清中抗CCP抗体滴度明显高于健康人群及其他结缔组织病患者.抗CCP抗体阳性对类风湿关节炎的诊断更具有价值.

abstractsObjective To determine the sensitivity and specificity of anti-cyclic citrullinated peptide antibodies (anti-CCP antibodies) in the diagnosis of rheumatoid arthritis. Method A total of 1018healthy donors, 212 patients with rheumatoid arthritis, 435 patients with other connective tissue disease were recruited to this study. Anti-CCP antibodies and IgM-rheumatoid factor (RF) were determined by ELISA according to manufacturer instructions, with a cut-off of 20U. Result The frequency of positive anti-CCP antibodies in patients with rheumatoid arthritis is 48.1% (n = 102 ), higher than healthy donors (2.6%,n = 26) and patients with other connective tissue diseases (3.7%, n = 16). The specificity of anti-CCP antibodies is 97.4%. The titer of anti-CCP antibodies in patients with rheumatoid arthritis (429. 7 U) is much higher than that in healthy donors (29. 3 U ) and patients with other connective tissue diseases (36. 5 U). The frequency of positive IgM-RF in patients with rheumatoid arthritis is 94. 3% whilst only21.5% in healthy donors. The false positivity rate of IgM-RF is higher than anti-CCP antibody. Conclusion Anti-CCP antibodies is a highly specific autoantibody in the diagnosis of rheumatoid arthritis.