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目的探讨第3代抗环瓜氨酸肽(CCP3)抗体在类风湿性关节炎(rheumatoid arthritis,RA)中的应用价值。方法收集就诊的RA患者45例(RA组),骨性关节炎(osteoarthritis,OA)和强直性脊柱炎(ankylosing sporidylitis,AS)患者共40例(OA和AS组),健康体检者40例(对照组),检测各组血清抗CCP3抗体及类风湿因子(rheumatoid factor,RF)水平,采用ROC曲线评价其对RA的诊断价值,采用平行试验分析两种抗体联合检测的诊断价值,并分析检测指标与X线分期的相关性。结果 RA组抗CCP3抗体及RF阳性率分别为71.11%、66.67%,高于对照组(5.00%、12.50%),高于OA和AS组(7.50%、17.50%),差异均有统计学意义(P<0.01)。抗CCP3抗体对RA诊断的敏感性为71.11%,特异性为93.75%,ROC曲线下面积(AUC)为0.844。RF对RA诊断的敏感性为66.67%,特异性为85.00%,AUC为0.763。抗CCP3抗体与RF联合检测的诊断敏感性为77.78%,特异性为81.25%,准确度为80.00%。抗CCP3抗体与患者X线分期成正相关(r=0.442,P<0.01)。结论抗CCP3抗体检测对RA具有较高的诊断和预后价值,抗CCP3抗体与RF联合检测将有助于提高RA的诊断率。抗CCP3抗体及RF均具有鉴别RA与OA、AS的临床价值。
Objective To investigate the anti-cyclic citrullinated peptide (CCP3) antibody in the third generation of rheumatoid arthritis (rheumatoid arthritis, RA). Methods Forty-five RA patients (RA group), 40 patients (OA and AS group) with osteoarthritis (OA) and ankylosing spondylitis (AS) were enrolled in this study. Forty healthy subjects CCP3 antibody and rheumatoid factor (RF) were detected in each group. The diagnostic value of ROC curve was evaluated by ROC curve. The diagnostic value of combined detection of two antibodies was analyzed by parallel test. Correlation between index and X-ray staging. Results The positive rates of anti-CCP3 antibody and RF in RA group were 71.11% and 66.67%, higher than those in control group (5.00% and 12.50%, respectively), higher than those in OA and AS groups (7.50% and 17.50% (P <0.01). The anti-CCP3 antibody had a sensitivity of 71.11% for RA diagnosis, a specificity of 93.75%, and an area under the ROC curve (AUC) of 0.844. The sensitivity of RF to RA diagnosis was 66.67%, specificity was 85.00%, and AUC was 0.763. The diagnostic sensitivity of anti-CCP3 antibody combined with RF was 77.78%, the specificity was 81.25% and the accuracy was 80.00%. Anti-CCP3 antibody was positively correlated with X-ray stage (r = 0.442, P <0.01). Conclusion The detection of anti-CCP3 antibody has a high diagnostic and prognostic value for RA. Combined detection of anti-CCP3 antibody and RF will be helpful to improve the diagnostic rate of RA. Anti-CCP3 antibodies and RF have the clinical value of identifying RA and OA, AS.