目的探讨联合检测血清中抗角蛋白抗体(抗AKA)、抗环瓜氨酸抗体(抗CCP)、抗RA33抗体、类风湿因子(RF)及红细胞沉降率(ESR)在诊断类风湿关节炎(RA)中的应用价值。方法收集该院2014年6月至2015年5月,经确诊的RA患者100例,疑似RA病例60例,对照组经确诊为非RA的其他自身免疫性疾病患者120例,分别用间接免疫荧光法(IFA)检测每组病例中的抗AKA抗体,用ELISA法检测抗CCP抗体和抗RA33抗体,用速率散射比浊法检测RF,用魏氏法检测ESR,并对各个诊断指标的诊断性能进行评价。结果抗AKA抗体、抗CCP抗体、抗RA33抗体、RF及ESR 5种检测指标在RA组中的检出率依次为64.0%、75.0%、44.0%、84.0%和51.0%,5项并联后的检出率(灵敏度)为97.0%,串联后的检测特异度为89.2%;在RA疑似组中5种检测指标的检出率依次为16.7%、31.7%、13.3%、20.0%、15.0%;在对照组中5种检测指标的检出率依次为0.8%、2.5%、1.7%、0.8%和5.8%,5种指标在RA组中的检出率显著高于疑似RA组,差异有统计学意义(P<0.001),疑似RA组和对照组相比5种指标的检出率差异有统计学意义(P<0.001),5项并联检测的灵敏度为97.0%,显著高于单项检测灵敏度(P<0.05),5项串联检测的特异度最高达到100.0%,也显著高于单项检测特异度(P<0.05),并联检测的漏诊率最低,阴性预测值最高,串联检测的误诊率最低,阳性预测值最高,并联检测的约登指数最大。结论抗CCP抗体和RF单独检测具有较好的灵敏度和特异度,而5种指标联合检测具有更高的灵敏度和特异度,可以更好地降低漏诊率和误诊率,大大地提高诊断效率,从而对RA的早期诊断具有重要的临床意义。 Objective To investigate the diagnostic value of anti-AKA, anti-cyclic citrullinated antibody (anti-CCP), anti-RA33 antibody, rheumatoid factor (RF) and erythrocyte sedimentation rate (ESR) in the diagnosis of rheumatoid arthritis RA) in the application value. Methods From June 2014 to May 2015, 100 cases of RA patients, 60 cases of suspected RA patients and 120 cases of other autoimmune diseases who were diagnosed as non-RA in the control group were collected from June 2014 to May 2015. The patients were divided into two groups by indirect immunofluorescence Anti-AKA antibody was detected by IFA in each group, anti-CCP antibody and anti-RA33 antibody by ELISA, RF by rate nephelometry, ESR by Wei’s method, and the diagnostic performance of each diagnostic index Evaluation. Results The detection rates of anti-AKA antibody, anti-CCP antibody, anti-RA33 antibody, RF and ESR in RA group were 64.0%, 75.0%, 44.0%, 84.0% and 51.0% The detection rate (sensitivity) was 97.0% and the specificity of detection in series was 89.2%. The detection rates of 5 detection indexes in RA suspect group were 16.7%, 31.7%, 13.3%, 20.0% and 15.0%, respectively. In the control group, the detection rates of the five detection indexes were 0.8%, 2.5%, 1.7%, 0.8% and 5.8%, respectively. The detection rates of the five indexes in RA group were significantly higher than those in suspected RA group (P <0.001). There was significant difference in the detection rate of the five indexes between the suspected RA group and the control group (P <0.001), the sensitivity of the five parallel tests was 97.0%, which was significantly higher than that of single detection sensitivity (P <0.05). The specificity of 5 series tests was up to 100.0%, which was significantly higher than that of single test (P <0.05). The rate of misdiagnosis was the lowest in parallel test and the highest in negative predictive value. The misdiagnosis rate of serial test was the lowest , The highest positive predictive value, the largest Youdend index in parallel detection. Conclusion Anti-CCP antibody and RF single detection have good sensitivity and specificity, and the five kinds of indexes combined detection has higher sensitivity and specificity, which can better reduce the rate of missed diagnosis and misdiagnosis, greatly improve the diagnostic efficiency, thus The early diagnosis of RA has important clinical significance.