抗CCP抗体IgG亚型在类风湿关节炎中的分布及临床价值  

Distribution and significance of IgG subclasses of anti-CCP antibodies in sera from patients with rheumatoid arthritis

作　　者：李俊[1] 陈佳喜[1] 沈益敏[1] 项梦莎 吴春龙[1] 沈波[1] 

机构地区：[1]浙江省台州医院检验科,临海317000

出　　处：《中华检验医学杂志》2015年第8期548-551,共4页Chinese Journal of Laboratory Medicine

摘　　要：目的探讨血清抗环瓜氨酸肽抗体IgG亚型在类风湿关节炎中的分布及意义。方法病例对照研究。2012年8月至2013年6月，收集83例台州医院类风湿关节炎（RA）患者、51例疾病对照组和50名健康对照组的血清，采用抗原特异性ELISA方法检测抗环瓜氨酸肽抗体（抗CCP—IgG）及其IgG亚型阳性率及浓度。采用X2检验和Kruskal—WallisH检验进行统计分析。结果抗CCP抗体及其IgG亚型阳性率分布为抗CCP—IgG71．1％（59／83）、抗CCP—IgGl78．3％（65／83）、抗CCP—IgG226．5％（22／83）、抗CCP-IgG360．2％（50／83）、抗CCP-IgG474．7％（62／83）。抗CCP—IgGl、抗CCP—IgG3和抗CCP—IgG4单独或联合检测的曲线下面积（AUC=0．818—0．901）与抗CCP．IgG单独检测（AUC=0．857）比较均无显著性差异（Z=0．028～0．045，P均〉0．05）。抗CCP-IgGl和抗CCP—IgG4阳性RA患者的DAS28评分值（DAS28=6．5、6．5）高于阴性RA患者（DAS28=4．5、4．6），差异有统计学意义（U=396．0、427．5，P均〈0．01）；抗CCP—IgGl和抗CCP—IgG4阳性RA患者的触痛关节数（T28=4．0、4．0）、肿胀关节数（SW28=4．0、4．0）高于阴性RA患者（T28=3．0、3．0，SW28=3．0、3．0），差异有统计学意义（U=377．5、406．0、255．5、286．5，P均〈0．05）。结论RA患者抗CCP抗体IgG亚型主要由抗CCP—IgGl、抗CCP—IgG3和抗CCP—IgG4组成，并与RA疾病活动度有关，抗CCP—IgG亚型联合检测能否替代抗CCP—IgG常规检测值得商榷。Objective To evaluate the distribution and significance of IgG subclasses of anti-cyclic cirullinated peptide antibody （anti-CCP） in sera from patients with rheumatoid arthritis （ RA ）. Methods A total of 83 patients with RA at the Department of Endocrinology of Taizhou Hospital, 51 disease controls and 50 healthy controls during the period from August 2012 to June 2013 were enrolled. The total serum IgG and IgG subclasses of anti-CCP antibodies were detected by antigen specific enzyme linked immune-sorbent assay（ELISA）. The prevalence and relative amount of IgG subclasses were calculated and compared. Statistical analysis was performed by X2 test and Kruskal-Wallis H test. Results The positive rates of IgG subclasses of anti-CCP were anti-IgG 71.1% （59/83）, anti-IgG1 78.3% （65/83）, anti-IgG2 26. 5% （22/ 83 ）, anti-IgG3 60. 2% （50/83）, anti-IgG4 74. 7% （ 62/83 ） respectively. The diagnostic value of anti-CCP- IgG1, anti-CCP-IgG3 and anti-CCP-IgG4 alone or combined（ AUC = 0. 818-0. 901 ）, compared with anti- CCP-IgG（ AUC = 0. 857）, had no significant difference （ Z = 0. 028 - 0. 045, P 〉 0.05 ）. The DAS28 score of anti-CCP-IgG1 （ DAS28 = 6. 5 ）, and anti-CCP-IgG4 （ DAS28 = 6. 5 ） positive in patients with RA were significantly higher than those in negative groups （ DAS28 = 4. 5,4. 6 ） （ U = 396. 0,427.5, P 〈 0.01 ）. The T28 （T28 =4. 0,4. 0）and SW28 （SW28 =4. 0,4. 0） resuhs of CCP - IgGland CCP -IgG4 positive in patients with RA were significantly higher than those in negative groups （ T28 = 3.0,3.0, SW28 = 3.0,3.0 ） （ U = 377.5,406. 0,255.5,286. 5,P 〈 0. 05 ）. Conclusions The distribution of IgG subclasses of anti-CCP in sera from patients with RA was predominantly anti-CCP-IgG1, anti-CCP-IgG3 and anti-CCP-IgG4 associated with RA disease activity. However, whether joint detection of IgG subclasses can replace conventional anti- CCP is questionable.

关 键 词：关节炎 类风湿 肽类 环 免疫球蛋白G 自身抗体 

分 类 号：R593.22[医药卫生—内科学]