抗环瓜氨酸肽抗体在不同发病年龄类风湿关节炎患者中的差异

Difference of anti-cyclic citrullinated peptide antibody in patients with rheumatoid arthritis in different age groups

目的比较抗环瓜氨酸肽（CCP）抗体在不同发病年龄类风湿关节炎（RA）患者中检测的意义。方法220例RA患者按发病年龄分为幼年组24例、成年组162例、老年组34例，采用ELISA法分别检测其外周血抗CCP抗体，免疫比浊法测定类风湿因子（RF）。结果幼年组、成年组和老年组患者中抗CCP抗体阳性率分别为14．3％（2／14）、81．7％（98／120）和67．9％（19／28），组间比较差异有统计学意义（Х^2=42．819，P〈0．001）；3组患者抗CCP抗体和R．F间具有良好的一致性，分别为71．4％（10／14）、82．2％（97／118）和82．1％（23／28）。抗CCP抗体仅与RA患者的X线分期呈正等级相关（Х^2=0．243，P=0．002）。幼年组抗CCP阳性者均出现在多关节型患者中，且抗CCP抗体与关节肿胀数和关节肿胀指数呈正直线相关（r=0．563，P=0．045；r=0．574，P=0．040）。老年组抗CCP抗体阳性者双手关节X线分期Ⅲ＋Ⅳ期所占比例明显高于抗CCP抗体阴性者[X线分级Ⅲ＋Ⅳ期占52．2％（12／23），Ⅰ＋Ⅱ期为0（0／9），Х^2=2．298，P=0．022]。结论抗CCP抗体在不同年龄发病组RA患者中阳性率不同。幼年组抗CCP抗体与多关节亚型有关，提示关节肿胀更重。老年组中抗CCP抗体阳性提示骨质侵蚀更严重。

Objective To evaluate the clinical value of anti-cyclic citrullinated peptide （anti- CCP） anti- body in patients with rheumatoid arthritis（RA） in different agegroup. Methods Anti-CCP antibody was detected by ELISA in 220 cases of RA who were divided into three groups by onset age： juvenile group （n = 24）, adult group （n = 162） and older age group （n = 34）. Results The ratio of anti-CCP in three groups were 14.3% （2/14）, 81.7% （98/120） and 67.9% （ 19/28 ） （ Х^2 = 42. 819, P 〈 0.01 ）. There was good coherence between the of anti- CCP and rheumatic factors （ RF）, with coherence coefficients of 71.4% （ 10/14 ）, 82.2% （97/118） and 82.1% （23/28）. Positive rank correlation was only found between anti-CCP and stages of X-rays（ rs = 0.243 ,P = 0. 002 ）. Patients of juvenile group with anti-CCP were all present in poly-article subtype. There was a linear correlation between anti-CCP and numbers of swollen joint, index of swollen joint in patients of juvenile group （ r = 0. 563, P = 0. 045 ; r = 0. 574,P = 0.040）. The stage of both hand joints in older patients with anti-CCP positive was poorer than in those with anti-CCP negative [ X-ray stage Ⅲ ＋ Ⅳ was 52.2% （ 12/23 ）, Ⅰ ＋ Ⅱ was 0 （0/9）, Х^2 = 2. 298, P = 0. 022 ]. Conclusion The incidences of anti-CCP vary significantly among different age patients with RA. Anti-CCP in patients of juvenile group is related with poly-joint subtype,indicating the worsened swollen of joint. Anti-CCP in older age-onset patients with RA means the more severity of bone erosion.