抗环瓜氨酸肽抗体在类风湿性关节炎诊断和治疗中的应用

The application of antibodies against cyclic citrullinated peptide (anti-ccp) in the diagnosis and treatment of rheumatoid arthtis (RA).

目的探讨抗环瓜氨酸肽抗体(Anti-CCP抗体)在类风湿性关节炎诊断和治疗中的应用。方法选择正常对照组20例,非类风湿性结缔组织病20例,类风湿性关节炎病人(RA)54例(其中活动期30例,非活动期24例),分别采用免疫散射比浊法测定抗体的浓度;用酶联免疫吸附(ELISA)法测定Anti-CCP抗体的浓度;用魏氏法测定血沉结果。比较了活动组和非活动组两组间Anti-CCP抗体、类风湿因子(RF)、红细胞沉降率(ESR)、C-反应蛋白(CRP)、有无显著性差异,同时各组的RF、Anti-CCP抗体指标与ESR、CRP的相关性进行分析。结果RF对RA的敏感性为74.1%,特异性为55%;Anti-CCP抗体对RA敏感性为51.9%,特异性为97.5%;活动组与非活动组Anti-CCP抗体与ESR、CRP呈正相关(P<0.05);活动组的RF与ESR、CRP呈正相关(P<0.05),而非活动组RF与ESR、CRP无相关性(P>0.05)。结论Anti-CCP抗体的敏感性较RF低,但特异性比RF高;Anti-CCP抗体比RF更能反映出RA活动期与非活动期的变化,且变化情况与CRP、ESR有一定的平行关系,可作为病情改善和恶化情况的判断,治疗有无效果的观察指标,适合于临床推广应用。

Objectives To investigate the application of antibodies against cyclic cilrullinated peptide （ anti -ccp antibodies ） in the diagnosis and treatment of rheumatoid arthritis （RA）. Methods 54 patients with RA（30 active phase and 24 inactive phase） ,20 patients with other connective tissue diseases other than RA and 20 healthy people were enrolled in the study. Enzyme linked immunosorbent assay （ELISA） was used to determine anti -CCP antibodies; rheumatoid factor （RF） and C -reactive protein（ CRP ） was measured by latex turbidimetric immunoassay and erythrocyte sedimentation rate （ESR） was measured by wei -shi method. We compared the differences in anti -ccp antibodies, RF, ESR and CRP between patients in active phase and patients in inactive phase by SAS system, we also analyzed the correlation between anti - CCP antibody titers and inflammatory markers such as ESR or CRP. Results The diagnostic sensitivity of anti - CCP antibodies for RA was 51.9% and the specificity was 97.5%, whereas the diagnostic sensitivity of RF was 74.1% and the specificity was 55%. Anti - CCP antibody titers positively correlated with ESR and CRP in active and inactive phase （ P 〈 0.05 ） ; RF was positively correlated with ESR and CRP in active phase （ P 〈 0.05 ）, but the correlation was not found in inactive phase （ P 〉 0.05 ）. Conclusion Our results suggest that anti - CCP antibody titers can better reflect the activity of RA and it is a better indicator of therapeutic effect as compared with RF.