【摘要】 目的:探讨抗瓜氨酸化的人纤维蛋白原抗体(ACF)在类风湿关节炎(RA)临床诊断中的价值。方法:采用肽酰精氨酸脱亚氨基酶将人纤维蛋白原在体外环境下催化成瓜氨酸化形式。采用ELISA方法对183例RA、121例系统性红斑狼疮、48例骨关节炎和108例健康对照者血清中的ACF水平进行检测,并与RA患者临床相关资料和实验室指标进行统计学分析。结果:ACF在RA、系统性红斑狼疮、骨关节炎和健康对照者中的阳性率分别为67.21%,25.62%,18.75%和2.78%,对RA的敏感性为67.21%,特异性为84.84%,阳性预测值为74.55%。RA患者中ACF的阳性率显著高于其他3组(P<0.001)。与RA临床及实验室指标比较显示,ACF与红细胞沉降率(r=0.386,P<0.001)、抗环瓜氨酸肽(CCP)抗体(r=0.239,P<0.05)和抗角蛋白抗体(AKA)(r=0.288,P<0.05)具有相关性。ACF阳性组与阴性组ESR、X线分期、IgM-RF、抗CCP抗体、AKA和抗核周因子的差异有统计学意义。另外,在IgM-RF、AKA和抗核周因子阴性患者中ACF具有较高的阳性率。结论:ACF在RA中具有较高的敏感性和特异性,且与红细胞沉降率、抗CCP抗体、AKA相关,ACF阳性患者更容易出现影像学改变。另外,ACF检测对于RA相关抗体阴性的患者具有辅助诊断价值。更多还原

【Abstract】 Objective: To study the prevalence of antibody to citrullinated human fibrinogen（ACF） in rheumatic diseases and the diagnostic values in rheumatoid arthritis.Methods: Human fibrinogen was deiminated by the peptidylarginine deiminase（PAD） in the presence of Ca²⁺ in vitro.ACF was detected by ELISA in 352 patients with rheumatic diseases（183 RA,121 SLE and 48 OA） and 108 healthy controls.The sensitivity and specificity in RA were calculated and the correlations between ACF and the clinical and laboratory parameters were analysed by SPSS statistical software.Results: Compared with SLE（25.62%）,OA（18.75%） and healthy control（2.78%） respectively,the patients with RA had a significantly higher level of ACF（67.21%,P<0.001）.ACF had a sensitivity of 67.21% and a specificity of（84.84%） for RA.In the investigated clinical and laboratory parameters of RA,the significant correlations were found between ACF and ESR（r=0.386,P<0.001）,anti-CCP antibody（r=0.288,P<（0.05）） and AKA（r=0.288,P<（0.05））,respectively.Abnormalities in ESR,radiographic progression,IgM-RF,anti-CCP,AKA and APF were more often in ACF positive patients than in ACF negative patients.Moreover,ACF was positive in 38.00% of IgM-RF negative,59.81% of AKA negative and（68.22%） of APF negative patients,respectively.Conclusion: ACF is a sensitive and specific antibody in diagnosing RA.The ACF test is also very useful in diagnosing RA with other autoantibodies negative.更多还原