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目的研究抗角蛋白抗体(AKA)、抗核周因子(APF)和抗环瓜氨酸肽抗体(抗-CCP)对于幼年特发性关节炎(JIA)各型诊断的意义。方法收集JIA患儿111例,正常对照30例,测定AKA、APF和抗-CCP水平,对JIA各型诊断的敏感性、特异性、阳性似然比、阴性似然比进行评价,利用敏感度和特异度绘制ROC曲线。结果多关节型与全身型、少关节型及附着点炎相关型检测结果差异较大;分别检测3种抗体,灵敏度为AKA>抗-CCP>APF,联合检测两种抗体灵敏度为AKA+抗-CCP>AKA+APF>APF+抗-CCP;特异性的比较,单一检测中抗-CCP,两项检测中APF+抗-CCP、AKA+抗-CCP及三项抗体联合检测特异性较高;阳性似然比APF+抗-CCP和三者联合检测较高。全身型中AKA、APF、抗-CCP单一及联合检测ROC曲线下面积接近0.5。多关节型AKA、APF及联合检测ROC曲线下面积为0.6～0.72,P均<0.05。结论AKA、APF及联合检测对于判定JIA多关节型有良好的灵敏度和特异度,是否可成为早期诊断的指标有待大样本研究证实。
Objective To study the significance of anti-keratin antibodies (AKA), anti-nuclear factor (APF) and anti-cyclic citrullinated peptide antibodies (anti-CCP) in diagnosis of various types of juvenile idiopathic arthritis (JIA) Methods 111 children with JIA and 30 normal controls were collected. The levels of AKA, APF and anti-CCP were measured. The sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of various types of JIA were evaluated. Sensitivity And specificity to draw the ROC curve. Results There were significant differences between the multi-joint type and the whole body type, the less joint type and the attachment-associated inflammation-related test results. The three antibodies were detected with sensitivity of AKA> anti-CCP> APF. The combined detection of the two antibodies was AKA + anti-CCP > AKA + APF> APF + anti-CCP; the specificity of anti-CCP in single test was higher than that of APF + anti-CCP, AKA + anti-CCP and three antibodies in two tests; the positive likelihood ratio APF + anti-CCP and triple detection of higher. The area under the ROC curve of single and combined detection of AKA, APF and anti-CCP in the whole body is close to 0.5. The area under ROC curve of multiarticular AKA, APF and combined detection was 0.6 ~ 0.72, all P <0.05. Conclusion AKA, APF and combined detection of JIA for determining the multi-joint type with good sensitivity and specificity, can be an indicator of early diagnosis remains to be confirmed by large sample studies.