血清、唾液6-磷酸葡萄糖异构酶抗原检测在类风湿关节炎诊断及鉴别诊断中的意义

Clinical Significance of Detection of Glucose-6-Phosphate Isomerase Antigen in Serum and Saliva in Diagnosis and Differential Diagnosis of Rheumatoid Arthritis

目的检测类风湿关节炎(RA)、未分化关节炎(UA)患者血清、唾液6-磷酸葡萄糖异构酶(GPI)抗原和血清抗环瓜氨酸肽(CCP)抗体,探讨GPI抗原在UA鉴别诊断及RA诊断中的价值。方法102例患者及33例健康对照。102例患者中76例符合RA诊断标准,10例符合UA诊断标准,其余16例为其他风湿病(包括SLE、AS等)患者。用ELISA方法检测全部患者血清GPI抗原、抗CCP抗体,其中42例同时检测唾液GPI抗原。结果RA组GPI浓度高于正常对照和其他风湿病组,后二者相比较无差异。用ROC曲线评价GPI对RA的诊断价值,以GPI取值为0.39时,约登指数最大,灵敏度为0.671,特异度为0.857,约登指数为0.528。唾液GPI抗原浓度与正常对照组相比较无差异。10例UA患者中,6例GPI阳性患者最后诊断为RA,另4例患者正在继续随访中。结论血清GPI对RA诊断具有较高的灵敏度和特异性,可作为除RF、抗CCP抗体以外诊断RA的新指标;与抗CCP抗体高度相关,二者联合检测可提高RA的诊断率,在UA鉴别诊断中有重要意义。

Objective To assess the clinical significance of glucose-6-phosphate isomerase（GPI） antigen in diagnosis and differential diagnosis of rheumatoid arthritis（RA） , by detecting GPI antigen and anti-cyclic eitrullinated peptid（CCP） antibodies in serum and saliva of patients with RA and undifrerentiated arthritis（ UA ）. Method The levels of serum GPI and anti-CCP antibodies were tested in 76 patients with RA, 10 palients with UA,16 non-RA controls with other rheumatism and 33 normal subjects by sandwich ELISA methods. The levels of saliva CPI in forly-lwo patients and all the normal subjects were also tesled. Results The levels of serum GPI antigen in RA patients were higher than those in both normal subjects and patients with other rheumatic diseases,while the latter two groups had no differences. When Ihe cut-off value was set at 0. 39μg/ml with ROC curve,the youde index was the highesl （0. 528 ） , while the sensitivity of GPI was 0. 671 ,the specificity was 0. 857 for RA. Among the 10 UA patients,6 patients who were finally diagnosed as RA wen; positive of GPI antigen,the other 4 patients were during follow-up. Conclusions Hecause of high sensitivity and specificity in RA diagnosis,lest of serum GPI levels can be used as a new marker of RA besides RF and anli-CCP antibodies. It is closely correlative with anli-CCP antibodies. Their eombination may increase Ihe diagnostic rate of RA. Particularly in the differential diagnosis of UA,it has important significance.