曹春花,阿祥仁

目的：探讨类风湿性关节炎（RA）相关的多种抗体如抗PAD4抗体、抗CEP-1抗体、抗Carp抗体、抗DUSP11抗体和14-3-3η蛋白对RA的敏感性和特异性，以及联合检测对RA的诊断价值；方法：收集2024年1月～2024年6月前来青海省人民医院就诊的诊断为类风性关节炎的患者92例作为研究对象，同期的体检人群作为对照组，共52例；采用ELISA法测定血清中的抗PAD4抗体、抗CEP-1抗体、抗Carp抗体、抗DUSP11抗体和14-3-3η蛋白；类风湿因子（RF）、C反应蛋白（CRP）的测定用免疫散射比浊法,抗环瓜氨酸肽（CCP）抗体的测定用化学发光法，PLT测定用电阻抗法。用受试者工作特征曲线（ROC）下面积（AUC）分析各指标单独或联合检测诊断RA的灵敏度和特异度。结果：两组间比较抗CCP抗体、RF、CRP、PLT、抗Carp抗体、抗PAD4抗体、抗CEP-1抗体、抗DUSP11抗体和14-3-3η蛋白水平差异均有统计学意义（P<0.001）。抗CEP-1抗体和抗PAD4抗体的诊断效能仅次于抗CCP抗体和RF，是诊断价值较好的两个指标。当抗CCP抗体和其他指标两两联合时，灵敏度和特异度显著升高，和抗CEP-1抗体、抗Carp抗体和抗PAD4抗体分别组合时AUC均大于0.990、灵敏度大于90%、特异度均达92%，优于抗CCP抗体和RF组合。而抗CCP抗体和多指标联合时，与抗Carp抗体+抗CEP-1抗体联合的AUC值最大为0.998，灵敏度96.7%、特异度100%；说明该组合是效提高RA诊断准确性的最佳组合。结论：本研究进一步论证了抗CEP-1抗体、抗Carp抗体、抗PAD4抗体、抗DUSP11抗体和14-3-3η蛋白对RA的特异性。抗CEP-1抗体、抗PAD4抗体是除了抗CCP抗体和RF外对RA诊断价值较好的两个指标，抗CCP抗体与各指标分别联合后，诊断效能显著提高，而抗CCP抗体与抗Carp抗体+抗CEP1抗体联合是诊断效能最佳的组合。

类风性关节炎；多种自身抗体；诊断价值

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