摘要：目的：抗瓜氨酸蛋白抗体(ACPAs)和类风湿因子(RF)常用于诊断类风湿关节炎(RA)。尽管这些抗体主要存在于RA患者，但其特异性并不理想。因此，仅仅依据ACPAs和RF难以识别RA患者，尤其是在病程早期。此外，抗氨基甲酰化蛋白(CarP)抗体对RA具有诊断和判断预后的价值，因为此抗体与RA患者关节损害有关，也与关节痛患者RA的发展有关。本研究的目的是探讨联合抗体检测对(早期)RA预测和诊断的价值。方法：通过文献检索结果确定了12项相关研究，研究对象包括RA患者、疾病发展前的RA患者、疾病对照组、RA患者的健康一级亲属和健康对照者，并获取RF、ACPAs和抗CarP抗体的实验室数据。利用这些数据，对几种抗体组合进行随机效应荟萃分析。结果：与对照组相比，单抗体在RA患者中的阳性率较高(34-80%)，但也存在于非RA疾病对照组中(0-23%)。ACPAs和(或)RF检测能较好的将大多数研究对象正确分类为RA或非RA对照组(特异性为65-100%，敏感性为59-88%)。联合检测ACPAs、RF、抗CarP抗体对RA的特异性较高(98-100%)，敏感性较低(11-39%)。结论：风湿病领域越来越趋向于RA的早期识别和对具有较低预测概率的人群进行RA最大风险个体的筛查,联合检测ACPAs、RF、抗CarP抗体可能有助于识别具有发展为RA风险的个体。

附原文：AbstractObjective：In rheumatoid arthritis (RA), anti–citrullinated protein antibodies (ACPAs) and rheumatoid factor (RF) are commonly used to aid in the diagnosis. Although these autoantibodies are mainly found in RA, their specificity is not optimal. It is therefore difficult to identify RA patients, especially in very early disease, based on the presence of ACPAs and RF alone. In addition, anti–carbamylated protein (anti‐CarP) antibodies have diagnostic and prognostic value, since their presence is associated with joint damage in RA patients and also associated with the future development of RA in patients with arthralgia. Therefore, the aim of the present study was to investigate the value of combined antibody testing in relation to prediction and diagnosis of (early) RA.Methods：A literature search resulted in identification of 12 relevant studies, consisting of RA patients, pre‐RA individuals, disease controls, healthy first‐degree relatives of RA patients, and healthy control subjects, in which data on RF, ACPAs, and anti‐CarP antibody status were available. Using these data, random effects meta‐analyses were carried out for several antibody combinations.Results：The individual antibodies were highly prevalent in patients with RA (34–80%) compared to the control groups, but were also present in non‐RA controls (0–23%). For the classification of most subjects correctly as having RA or as a non‐RA control, the combination of ACPAs and/or RF often performed well (specificity 65–100%, sensitivity 59–88%). However, triple positivity for ACPAs, RF, and anti‐CarP antibodies resulted in a higher specificity for RA (98–100%), accompanied by a lower sensitivity (11–39%).Conclusion：As the rheumatology field is moving toward very early identification of RA and possible screening for individuals at maximum risk of RA in populations with a low pretest probability, an autoantibody profile of triple positivity for ACPAs, RF, and anti‐CarP provides interesting information that might help identify individuals at risk of developing RA.

引自：MarijeK.Verheul,StefanBohringer,MyrtheA.M.vanDelft,JonathanD.Jones,WilliamF.C.Rigby,RyanW.Gan,etal.TriplePositivityforAnti–CitrullinatedProteinAutoantibodies,RheumatoidFactor,andAnti–CarbamylatedProteinAntibodiesConferringHighSpecificityforRheumatoidArthritis.Arthritis&Rheumatology2018;70:1721–1731.