抗环瓜氨酸肽抗体在类风湿关节炎中的意义

Diagnostic significance of anti-cyclic citrullinated peptide antibody and its predictive value for radiological progression in patients with rheumatoid arthritis

目的：探讨抗环瓜氨酸肽（CCP）抗体对类风湿关节炎（RA）的诊断意义及与RA影像学病情进展的关系，并了解抗CCP抗体与IgM型类风湿因子（IgM—RF）、抗角蛋白抗体（AKA）、抗核周因子（APF）及HLA—DRB1＊04等位基因的相关性。方法：酶联免疫吸附测定（ELISA）法检测39例RA、32例非RA病例及30名正常人血清的抗CCP抗体；对RA患者X线双手相进行2—9年随访，按照RA的Steinbrocker疾病分期将X线病情进展分为Ⅰ、Ⅱ、Ⅲ和Ⅳ期，观察下列因素对RA病情进展有否影响：性别、发病年龄、病程、起病关节、关节外表现、抗CCP抗体、IgM—RF、ANA、AKA、APF、抗RA33抗体及HLA—DRB1＊04等位基因等。结果：抗CCP抗体对RA诊断的敏感性为84．6％，特异性为96．8％，阳性预测值为94．3％，阴性预测值为91．0％。抗CCP抗体与IgM—RF、AKA、APF及HLA—DRB1＊04的相关性无统计学意义；Logistic回归分析显示只有HLA—DRB1＊04等位基因对RA影像学病情进展具有显著性意义（P=0．044，回归系数r=0．206，期望值Exp=8．256），未发现抗CCP抗体与RA骨侵蚀进展具有相关性。结论：抗CCP抗体可作为RA良好的诊断指标；抗CCP抗体对RA病情严重性及预后判定的意义有待进一步探讨。

Objective：To explore the diagnostic significance of anti - cyclic citrullinated peptide antibody （ anti - CCP） and its predictive value for radiological progression in patients with rheumatoid arthritis （RA） and investigate the association of anti - CCP with IgM -rheumatoid factor （IgM -RF） , anti -keratin antibodies （AKA） ,antiperinuclear factor （APF） , and human leukocyte antigen （HLA） - DRB1 alleles. Methods：Anti - CCP was tested by an enzyme - linked immunosorbent assay （ELISA） in serum samples from 39 patients with RA, 33 non - RA controls with various rheumatic diseases and 30 healthy individuals, and the diagnostic significance of anti - CCP was evaluated. Thirty - nine RA cases had taken hand X - ray photography in every 1 - 2 years and been followed up for 2 - 9 years. Logistic regression was used to analyze the factors which may impact the radiological progression of RA, such as sex, age of onset, disease duration, the joint onset, extra- articular involvements, anti- CCP, IgM - RF, ANA, AKA, APF, anti - RA33 antibodies and HLA - DRB1 ＊ 04 alleles. Results：The diagnostic sensitivity and specificity of anti - CCP were 84. 6%, 96. 8%, respectively. No significant association was found between anti - CCP and IgM - RF, AKA, APF or HLA - DRB1 alleles. The follow - up study showed that only HLA - DRB1 ＊ 04 alleles were significantly associated with the radiological progression of RA （ P = 0. 044, r = 0. 206, Exp = 8. 256 ）, and no significant association was found between anti - CCP and erosive disease. Conclusion： Anti - CCP is a valuable diagnostic marker for RA. No significant association is found between anti -CCP and the radiological progression of RA.