HLA-DR4与抗CCP抗体、抗Sa抗体联合检测对类风湿性关节炎的诊断价值

doi:10.3969/j.issn.1673-8640.2016.010.012

摘要/Abstract

摘要：

目的探讨人类白细胞抗原（HLA）-DR4、抗环瓜氨酸肽（CCP）抗体和抗Sa抗体对类风湿性关节炎（RA）的临床诊断价值,为RA的发病机制研究提供临床依据。方法选择RA患者148例及体检正常者（正常对照组）50名,采用序列特异引物引导的聚合酶链反应（PCR）检测HLA-DR4,酶联免疫吸附试验（ELISA）检测抗CCP抗体、抗Sa抗体,对检测结果进行危险因素分析和联合检测分析。结果 RA组HLA-DR4、抗CCP抗体、抗Sa抗体阳性率明显高于正常对照组,此3项指标是与RA关联性较强的正关联危险因素[比值比（OR）分别为3.28、172.63、34.21]。 RA组HLA-DR4、抗CCP抗体和抗Sa抗体诊断RA的敏感性分别为45.95%、78.38%、40.54%,约登指数分别为0.35、0.78、0.41。抗CCP抗体与抗Sa抗体并联、HLA-DR4与抗CCP抗体并联、HLA-DR4与抗Sa抗体并联的约登指数分别为0.87、0.74、0.54。结论 HLA-DR4是RA的正关联危险因素,与RA的发生、发展存在一定联系,与抗CCP抗体和抗Sa抗体联合检测可提高其对RA的诊断价值。

关键词: 人类白细胞抗原-DR4, 抗环瓜氨酸肽抗体, 抗Sa抗体, 类风湿性关节炎

Abstract:

Objective To investigate the determinations of human leucocyte antigen（HLA）-DR4,anti-cyclic citrullinated peptide（CCP） antibody and anti-Sa antibody for the diagnosis of rheumatoid arthritis（RA）,and to provide a reference for clinical diagnosis. Methods A total of 148 patients with RA（RA group） and 50 healthy subjects （healthy control group） were enrolled. The levels of HLA-DR4 were determined by sequence specific primer polymerase chain reaction（PCR）,and the levels of anti-CCP antibody and anti-Sa antibody were determined by enzyme-linked immunosorbent assay （ELISA）. Risk factor analysis and the evaluation of combined determinations were performed.Results The positive rates of HLA-DR4, anti-CCP antibody amd anti-Sa antibody in RA group were higher than those in healthy control group, and there were positive correlations of HLA-DR4,anti-CCP antibody and anti-Sa antibody with RA [odds ratios（OR） were 3.28,172.63 and 34.21]. The sensitivities of HLA-DR4,anti-CCP antibody and anti-Sa antibody in RA group were 45.95%,78.38% and 40.54%,and Youden indices were 0.35,0.78 and 0.41,respectively. The Youden indices of the combined determinations of anti-CCP antibody with anti-Sa antibody,HLA-DR4 with anti-CCP antibody and HLA-DR4 with anti-Sa antibody were 0.87,0.74 and 0.54. Conclusions There is a positive correlation of HLA-DR4 with the occurrence and development of RA,and the combined determination of anti-CCP antibody and anti-Sa antibody can improve the diagnosis of RA.

Key words: Human leucocyte antigen-DR4, Anti-cyclic citrullinated peptide antibody, Anti-Sa antibody, Rheumatoid arthritis

中图分类号:

R446.62

李笑峰, 鲁旭娟. HLA-DR4与抗CCP抗体、抗Sa抗体联合检测对类风湿性关节炎的诊断价值[J]. 检验医学, 2016, 31(10): 894-897.

LI Xiaofeng, LU Xujuan. The combined determinations of HLA-DR4,anti-CCP antibody and anti-Sa antibody for the diagnosis of rheumatoid arthritis[J]. Laboratory Medicine, 2016, 31(10): 894-897.

图/表 3

参考文献 11

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组别	例数	HLA-DR4	抗CCP抗体	抗Sa抗体
RA组	148	68（45.95）	116（78.38）	60（40.54）
正常对照组	50	7（14.00）	0（0.00）	0（0.00）
OR值		3.28	172.63	34.21
P值		0.00	0.00	0.00

组别	例数	HLA-DR4	抗CCP抗体	抗Sa抗体
RA组	148	68（45.95）	116（78.38）	60（40.54）
正常对照组	50	7（14.00）	0（0.00）	0（0.00）
OR值		3.28	172.63	34.21
P值		0.00	0.00	0.00

指标	敏感性（%）	特异性（%）	准确度（%）	阳性似然比（%）	阴性似然比（%）	约登指数
HLA-DR4	45.95	86.00	56.06	3.28	0.59	0.35
抗CCP抗体	78.38	100.00	83.84	0.00	0.22	0.78
抗Sa抗体	40.54	100.00	55.56	0.00	0.59	0.41

指标	敏感性（%）	特异性（%）	准确度（%）	阳性似然比（%）	阴性似然比（%）	约登指数
HLA-DR4	45.95	86.00	56.06	3.28	0.59	0.35
抗CCP抗体	78.38	100.00	83.84	0.00	0.22	0.78
抗Sa抗体	40.54	100.00	55.56	0.00	0.59	0.41

指标	敏感性（%）	特异性（%）	约登指数
抗CCP抗体与抗Sa抗体并联	87.14	100.00	0.87
HLA-DR4与抗CCP抗体、抗Sa抗体串联	88.39	86.00	0.75
HLA-DR4与抗CCP抗体并联	88.31	86.00	0.74
HLA-DR4与抗Sa抗体并联	67.86	86.00	0.54
HLA-DR4与抗CCP抗体串联	36.02	100.00	0.36