4种自身抗体在幼年特发性关节炎早期诊断和预后评估中的意义

Early diagnostic and predictive value of antikeratin antibody,anti-cyclic citrullinated peptide antibody,and rheumatoid factors in juvenile idiopathic arthritis

目的探讨免疫学指标抗角蛋白抗体(AKA)、抗环瓜氨酸肽(抗CCP)、类风湿因子(RF)-IgG、RF-IgM与各分型幼年特发性关节炎(JIA)患儿早期诊断和预后之间的关系。方法收集76名经系统治疗并坚持随访治疗至少6个月的JIA患儿,在诊断初期进行AKA、抗CCP、RF-IgG、RF-IgM等免疫指标的检测,对不同亚型和预后作阳性检出率的比较,进行敏感性、特异性、相关危险度的统计学分析,并与49例健康儿童作对照比较。结果多关节炎型组的AKA、抗CCP、RF-IgG、RF-IgM的阳性检出率与正常对照组比较差异有统计学意义,全身型、少关节型、附着点炎相关型的自身抗体阳性检出率与正常对照组差异无统计学意义。4种抗体的检测对多关节炎型组的分型敏感性依次为AKA>抗CCP,RF-IgG>RF-IgM;特异性依次为RF-IgM>AKA>RF-IgG>抗CCP。难治型JIA患儿的AKA阳性检出率与普通JIA患儿差异有统计学意义;相对危险度OR为3.514。结论 AKA、抗CCP、RF-IgG、RF-IgM在JIA不同亚型早期诊断中的作用有区别;AKA、抗CCP抗体的检测对JIA多关节炎型有较好的敏感性和特异性;AKA抗体的出现与难治型JIA相关,是否能作为成为多关节炎型早期诊断和预后评估的血清学指标,有待大样本的研究证实。

Objective To investigate the value of antikeratin antibody（AKA）,anti-cyclic citrullinated peptide antibody（anti-CCP）and rheumatoid factor（RF-IgG,RF-IgM）in early diagnosis and prediction of juvenile idiopathic arthritis（JIA）.Methods Seventy-six patients with JIA were enrolled and follow-up at least 6 months.The blood samples were collected to measure AKA,anti-CCP,RF-IgG,RF-IgM upon admission.The frequency of positive AKA,anti-CCP,RF-IgG and RF-IgM in different subtype and refractoriness were compared.Forty-nine healthy children were enrolled as control group.Results Compared with control group,the positive rates of AKA,anti-CCP,RF-IgG and RF-IgM were significantly higher in polyarticular subgroup,but there were no difference in other subtypes.The sensitivity was AKA anti-CCP,RF-IgG RF-IgM.The specificity was RF-IgM AKA RF-IgG anti-CCP.The positive rate of AKA was significantly higher in refractory JIA than that in common JIA.The relative risk estimate（OR）was 3.514.Conclusions AKA,anti-CCP,RF-IgG,RF-IgM have different values in early diagnosis and the subtype of JIA.AKA,anti-CCP are sensitive and specific in distinguishing polyarticular subgroup.AKA may predict refractory JIA.