类风湿性关节炎患者抗环瓜氨酸肽抗体的临床应用

Clinical utility of anti-citrullinated peptide antibodies in patients with rheumatoid arthritis

目的探讨抗环瓜氨酸肽(CCP)抗体检测在类风湿性关节炎(RA)中的临床应用。方法采用酶联免疫吸附试验(ELISA)检测163份血清(RA患者85例,非RA患者48例,健康体检者30例)抗CCP抗体,绘制ROC曲线了解抗CCP抗体对RA的临床诊断效能,分析抗CCP抗体等一些实验室指标与病程和病情的关系以及它们之间的相关性。结果抗CCP抗体在RA组血清中的阳性率为74.2%,明显高于非RA组的2.5%和正常对照组的0.0%(P值均<0.001)。抗CCP抗体对初诊RA的敏感性和特异性为79.0%和96.0%,而类风湿因子(RF)的敏感性和特异性为80.6%和68.0%,两者特异性的差异有显著性(P<0.01),但抗CCP抗体的水平与病程及病情活动度不相关。结论抗CCP抗体是一项高度特异性的临床诊断RA的血清学指标,在RA早期即有很高的敏感性,但其与RA疾病的进展及预后的关系有待进一步深入研究。

Objective To appraise the clinical utility of anti-citrullinated peptide antibodies （anti-ccp） in a cohort of patients with rheumatoid arthritis （RA）. Methods Anti-ccp2 were detected with enzyme linked immunoassay （ELISA） in 163 serum samples （85 with RA, 48 with non-RA, 30 from healthy controls）. The diagnostic ability of anti-ccp was expressed as a receiver operating characteristic （ROC） area under the curve （AUC）. At the first visit from the patienfs history, physical examination, blood and imaging tests were entered in a correlative analysis. Results The positive rate of anti-ccp with RA was 74.2 %, and was significantly higher than that of the non-RA group （2.5%） and that of the controls group （0.0%, P〈0. 001）. The ROC AUC of anti-ccp was 0. 967 for diagnosis of RA, whereas the diagnostic ability of RF was significantly lower, with ROC AUC values of 0. 809. There was no difference in the sensitivity of both anti-ccp and RF, but the specificity of anti-ccp was significantly greater than that of RF. There were no correlation and no statistical difference among the levels of anti-ccp and duration of disease and activity. Conclusions Anti ccp antibody is an excellent serological marker for RA, which shows high diagnostic specificity and is detectable at an early stage, but the role of anti-ccp in the prediction of disease progression is yet to be investigated further. （Shanghai Med J, 2005, 28：1040-1043）