抗环瓜氨酸肽抗体与类风湿关节炎疾病活动及骨侵蚀关系的研究

Anti-cyclic citrullinated peptide antibody in rheumatoid arthritis： relation with disease activity and bone erosion

目的探讨类风湿关节炎（RA）患者抗环瓜氨酸肽（CCP）抗体、类风湿因子（RF）与疾病活动度、功能状态及骨侵蚀的关系。方法人选RA患者218例，健康对照41名，ELISA法检测抗CCP抗体，乳胶凝集法检测RF，同时记录RA患者的临床资料。分析抗CCP抗体、RF阳性和阴性患者中疾病活动指数28（DAS28）、健康评估问卷（HAQ）的变化，并探讨其中124例病程〉2年的患者抗CCP抗体、RF与骨侵蚀的关系。结果RA患者中抗CCP抗体阳性率为76％，RF阳性率勾71％。DAS28评分在抗CCP抗体、RF阳性患者明显高于阴性患者（P〈0．05）；抗CCP抗体浓度与DAS28评分相关（r=0．385，P=0．032）；RF滴度与DAS28评分相关（r=0．141，P=0．037）；红细胞沉降率（ESR）、C反应蛋白（CRP）及HAQ评分在抗CCP抗体、RF阳性和阴性患者之间的差异无统计学意义（P〉0.05）。抗CCP抗体阳性患者更易出现骨侵蚀，与阴性患者相比。差异有统计学意义（P〈0．05）。RF阳性和阴性患者之间骨侵蚀的差异无统计学意义。结论抗CCP抗体、RF与疾病活动度相关，抗CCP抗体阳性患者更易出现骨侵蚀，但RF与骨侵蚀未表现出相关性。

Objective To compare the correlation between anti-cyclic eitrullinated peptide antibody （anti-CCP）, rheumatoid factor （RF） and disease activity, functional capacity, bone erosion of rheumatoid arthritis （RA）. Methods The correlation between anti-CCP, RF and disease activity score 28 （DAS28）, health assessment questionnaire（HAQ） and bone erosion was assessed. Results Among the 218 RA patients, 76% were anti-CCP-positive and 71% were RF-positive. The mean DAS28 score of RA patients with anti-CCP-positive and RF-positive was significantly higher than patients without anti-CCP and RF. The serum anti-CCP levels and RF levels showed a significant correlation with DAS28 score. However, the HAQ scores, ESR and CRP levels showed no significant difference between anti-CCP-positive and anti-CCP-negative patients. RF-positive and RF-negative patients. Among anti-CCP-positive RA patients, the number of patients with erosive disease was significantly higher than patients without anti-CCP. However, the number of patients with erosive disease was not significantly different between RF-positive and RF-negative patients. Conclusion Anti-CCP and RF are associated with disease activity. Anti-CCP is associated with bone erosion. No association is found between RF and bone erosion.