联合检测ICTP、抗CCP抗体等在类风湿关节炎早期诊断中的临床研究  

Application of combined detection of pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen and anti-cyclic citrullinated peptide antibody in rheumatoid arthritis early diagnosis and treatment

作　　者：戴金华[1] 乐爱平[2] 葛志斌[1] 邬秀娣[1] 马建波[1] 

机构地区：[1]浙江省宁波市第二医院,浙江宁波315010 [2]南昌大学第一附属医院,南昌330006

出　　处：《中国卫生检验杂志》2010年第9期2206-2209,共4页Chinese Journal of Health Laboratory Technology

基　　金：宁波市医学科技计划项目(2008007)

摘　　要：目的:探讨Ⅰ型胶原吡啶交联终肽(ICTP)、抗环瓜氨酸肽(CCP)抗体及其它相关实验指标血清水平和联合检测在早期RA诊断与病情监测中的应用。方法:对入选的确诊早期RA116例、非RA组57例、正常对照组48例分别测定ICTP、抗CCP抗体、RF、CRP等,并记录相应的临床指标如性别、年龄、病程、晨僵时间、关节受累数等。结果:(1)抗CCP抗体、RF、CRP在RA各组血清水平均高于非RA组及对照组(P<0.05),抗CCP抗体在非RA组与正常对照组间比较,差别则无统计学意义(P>0.05);ICTP在中晚期显示较高含量,显著高于其它各组(P<0.05),早期RA组与非RA组中ICTP量值比较差别不明显(P>0.05),但与正常对照比较,均有差别(P<0.05)。(2)单项检测中对早期RA诊断的敏感性最高为RF,特异性指标最高为抗CCP抗体,抗CCP抗体等联合检测可提高对早期RA诊断的特异性,ICTP、抗CCP抗体、RF、CRP四项联合检测特异性达100%。(3)早期RA患者中多关节受累组和骨侵蚀组的血清ICTP、抗CCP抗体、RF、CRP水平均显著高于少关节受累组和无骨侵蚀组(P<0.05);血清ICTP、抗CCP抗体等与关节受累、骨侵蚀相关。(4)单纯使用非甾类抗炎药(NSAIDs)治疗早期RA患者,ICTP水平有上升趋势;患者采用抗风湿缓解药(DMARDs)治疗,ICTP半年内血清水平前后比较差别无统计学意义(P>0.05),抗CCP抗体在治疗后水平降低(P<0.05)。结论:联合检测抗CCP抗体、ICTP、RF等,可提高早期RA诊断的准确性,有重要临床意义;动态联合检测可有效监测RA病情进展及评价临床疗效;ICTP及抗CCP抗体能作为常规用于RA临床观察的实验室重点指标。Objective：To exam the pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen（ICTP）,anti-cyclic citrullinated peptide（CCP） antibody,rheumatoid factor（RF） and C-reative protein（CRP） and to evaluate the clinical value of combined detection in rheumatoid arthritis（RA） early diagnosis and monitoring.Methods： Serum levels of ICTP,anti-ccp antibody were measured by ELISA,RF and CRP by immunonephelometry assay in 116 RA and 57 non-RA patients and 48 normal controls.The clinical and laboratory data were recorded,including gender,age,course of disease,time of morning stiffness,counts of swelling and painful joint,and so on.Results：（1） The serum levels of anti-ccp antibody,RF and CRP in RA patients were higher than non-RA patients and normal controls（P〈0.05）;There was no significance about the level of anti-ccp antibody among in non-RA patients and normal controls（P〉0.05）;The concentration of ICTP just in mid-advanced RA group was higher than in early RA patients and the other groups（P〈0.05）,early RA patients did not differ from non-RA patients（P〉0.05）,but significant difference was found between RA,non-RA patients and normal controls（P〈0.05）.（2） The sensitivity of RF and the specificity of anti-ccp antibody was higher than the other each individual antibody as a better diagnostic discriminator in early RA,Combination of anti-ccp antibody and either one increased the specificity,the specificity to diagnosis of early RA of anti-ccp antibody combinding with ICTP,RF,CRP was 100%.（3） ICTP and anti-ccp antibody,RF,CRP were correlated with the counts of damaged joints,and bone erosion;The concentration of ICTPand anti-ccp antibody,RF,CRP in multi-articalationbone erosion early RA patients were higher than in oligo-articulation,non-bone-erosion（P〈0.05）.（4） The serum level of ICTP in early RA patients was improved after treatment with nonsteroidal anti-inflammatory drugs（NSAID） only,but as compared with normal controls,did not show

关 键 词：Ⅰ型胶原吡啶交联终肽 抗环瓜氨酸肽抗体 RF CRP 类风湿关节炎 临床诊断监测 

分 类 号：R593.22[医药卫生—内科学]