三种抗瓜氨酸抗体诊断类风湿性关节炎的临床价值研究  

Diagnostic value of three types of anti-cirullinated peptide antibodies in rheumatoid arthritis

作　　者：郭静[1] 李茹 何菁[2] 栗占国[2] 王永福[1] 

机构地区：[1]包头医学院第一附属医院风湿免疫科,包头014010 [2]北京大学人民医院风湿免疫科,北京100044

出　　处：《中国实用内科杂志》2011年第11期850-852,共3页Chinese Journal of Practical Internal Medicine

基　　金：十一五科技支撑计划(2008BAI59B01)

摘　　要：目的研究血清中抗核周因子(APF)、抗角蛋白抗体(AKA)及抗环瓜氨酸多肽(CCP)抗体在类风湿性关节炎(RA)诊断中的意义。方法随机选择2006年1月至2009年8月于北京大学人民医院风湿免疫科住院的RA患者500例,应用酶联免疫吸附法检测抗CCP抗体,间接免疫荧光法检测APF和AKA,分析比较3种抗体在RA诊断中的敏感度及其与临床特点及免疫学指标的关系。结果 (1)500例RA患者中抗CCP、APF和AKA抗体诊断的敏感度分别为70.8%、51.8%和45.0%,其中抗CCP抗体敏感度明显优于APF和AKA(P<0.01)。(2)在146例抗CCP阴性的患者中APF的诊断敏感度高于AKA抗体,但差异无统计学意义(16.4%对8.9%,P=0.059)。(3)抗CCP抗体和APF抗体阳性RA患者的关节肿痛数、DAS28评分均明显高于抗体阴性患者(P均<0.001);AKA抗体阳性患者DAS28评分也明显高于AKA阴性患者(P=0.02);APF和AKA抗体阳性患者年龄较抗体阴性患者明显增高(P均<0.05),而抗CCP抗体与年龄无关(P=0.88)。(4)抗CCP抗体阳性患者ESR、IgA、IgM、IgG、RF-IgG、RF-IgM、RF-IgA水平均明显高于抗体阴性组(P均<0.05);与APF抗体阴性患者比较,APF抗体阳性者具有较高的红细胞沉降率(ESR)、IgA、IgG、RF-IgG、RF-IgM、RF-IgA水平(P均<0.05);AKA抗体阳性仅与RF-IgG、RF-IgA明显相关(P=0.02),而与ESR及免疫球蛋白无关(P均>0.05)。结论抗CCP抗体在RA诊断中的敏感度和与病情活动度的相关性均优于APF抗体,APF优于AKA抗体。Objective To evaluate the diagnostic value of serum anti-perinuclear factor （APF）, anti-keratin antibody （AKA） and anti-cyclic cirullinated peptide （anti-CCP） antibody in rheumatoid arthritis. Methods Five hundred RA patients from Beijing University People＇s Hospital were randomly selected and studied for serum anti-CCP with enzyme-linked immunosorbent assay （ELISA）, serum APF and AKA with indirect immunofluorescence. The sensitivity of APF, AKA and anti-CCP tests in diagnosis of RA was compared. Correlations of these antibodies with clinical and serologic characteristics of RA were also analyzed. Results （ 1 ） Among the 500 patients,the sensitivity of anti-CCP test was 70. 8%, significantly higher than that for APF （51.8%） and AKA （45.0%） tests （P 〈0.01）. （2） Among 146 patients who tested negative for anti-CCP,the APF appeared more diagnostically sensitive than AKA, but the difference was not statistically significant （ 16. 4% vs 8. 9%, P = 0. 059 ）. （3） Patients who tested positive for both anti-CCP and APF had more painful joints and significantly high- er DAS28 scores than did those who tested negative for both （P 〈 0. 001 ）. DAS28 score was also higher in AKA- positive than in AKA-negative patients （P = 0. 02）. Advanced age was shown to correlated with positive findings of APF and AKA tests （ P 〈 0. 05 ） but not with anti-CCP （ P = 0. 88）. （4） Among common serologic parameters, the levels of ESR, IgA, IgM, IgG, RF-IgG, RF-IgM and RF-IgA were elevated in anti-CCP-positive than in antiCCP-negative patients （ all P 〈 0. 05 ）. APF positive patients had higher levels of ESR, IgA, IgG, RF-IgG, RF-IgM and RF-IgA than APF-negative patients （all P 〈0. 05 ）. AKA-positive test was correlated only with RF-IgG and RF-IgA （P = 0. 02） but not with ESR or immunoglobins. Conclusion Diagnostic sensitivity and correlation with RA disease activity is reflected by superiority of anti-CCP over APF, and APF over AKA.

关 键 词：类风湿性关节炎 抗环瓜氨酸多肽抗体 抗核周因子 抗角蛋白抗体 

分 类 号：R593.22[医药卫生—内科学]