抗核周因子检测与在类风湿关节炎中意义.docVIP

抗核周因子检测与在类风湿关节炎中意义 抗核周因子的检测及其在类风湿关节炎中的意义 2010-03-24 钱龙　曾庆馀　黄少弼　肖征宇　许杰洲　谢素和 　　【摘　要】　目的　了解抗核周因子(APF)对类风湿关节炎(RA)的诊断价值，并探讨其和RA病情的关系。方法　以健康人颊粘膜细胞为抗原，采用间接免疫荧光法检测143例RA、184例其他风湿病患者和168例正常人的血清APF；RA病人的红细胞沉降率(ESR)、类风湿因子(RF)、抗鼠食管角质层抗体(AKA)、抗RA 33抗体、医生和患者病情活动性评价、压痛及肿胀关节指数、放射学病情进展改进的Sharp评分也同时评估。结果　以1∶10为阳性阈值，APF对RA诊断的敏感性为67.8%(97/143)，对照组9例阳性，特异性97.4%；41例早期RA检出率为65.9%(27/41)；APF阳性RA的RF阳性率及滴度较阴性者高(79.3%对51.9%，1∶80对1∶52)，ESR、医生和患者病情活动性评价、AKA阳性率也高于阴性组；抗RA33抗体阳性率Sharp评分在两组间无差异。结论　APF有助于RA的诊断及早期诊断，可能是RA病情活动性及严重性指标之一。 　　【关键词】　抗核周因子　　自身抗体　　关节炎，类风湿 Detection of antiperinuclear factor and its clinical significance 　　QIAN Long,ZENG Qingyu,HUANG Shaobi,et al.Anhui Provincial Hospital,Hefei,230001 　　【Abstract】　Objective　To determine the significance of antiperinuclear factor (APF) in the diagnosis of rheumatoid arthritis (RA),and its relationship with disease activity and severity.Methods　Based on the antigenic substrate in human bucca mucosa cells,APF was measured with indirect immunofluorescence technique in 143 patients with RA,184 with miscellaneous rheumatic diseases and 168 healthy individuals.The erythrocyte sedimentation rate (ESR),C-reactive protein,RF,antibodies to the stratum of rat oesophagus (AKA),anti-RA33 antibodies,patient′s and physician′s global assessment of disease activity,tender joint count,swollen joint count and modified Sharp′s radiological progression scores were compared between APF positive and negative RA patients.Results　At the titer of 1∶10,APF was detected in 67.8% (97/143) of RA patients,and 9 cases of control group.The diagnostic specificity for RA was 97.4%.The occurrence of APF in the early RA was 65.9% (27/41).The patients′s and physician′s global assessment of disease activity,ESR,AKA,RF positive rate and its mean titer in APF-positive RA cases were significantly higher than those in APF-negative ones.Conclusion　APF is a valuable diagnostic tool and a useful additional marker for RA,and might be a useful prognostic marker and a test of the dise