血清葡萄糖-6-磷酸异构酶抗原和抗环瓜氨酸肽抗体在类风湿关节炎诊断及治疗中的意义

Significance of diagnoses and treatment that detect glucose-6-phosphate isomerase and anti-cyclic citrullinated peptide antibody in rheumatoid arthritis

目的探讨血清葡萄糖-6-磷酸异构酶(GPI)抗原和抗环瓜氨酸肽(CCP)抗体在类风湿关节炎(RA)诊治中的意义。方法用酶联免疫吸附试验分别检测41例活动期RA患者口服来氟米特治疗前、治疗12周、24周及健康对照组血清中的GPI抗原和抗CCP抗体水平,并与RA患者临床活动指标进行比较分析。结果 (1)血清GPI抗原和抗CCP抗体对RA诊断的敏感性分别为87.8%和90.2%,两者差异无统计学意义(P=1.000)。(2)治疗前患者血清GPI抗原和抗CCP抗体水平分别为(3.33±1.88)μg/ml和(84.10±36.26)U/ml,明显高于正常对照组(P<0.001);治疗12周及24周血清GPI抗原较治疗前明显降低(P<0.001),而抗CCP抗体无明显改变(P>0.05)。(3)血清GPI抗原水平在治疗前及治疗过程中与年龄、压痛关节数、肿胀关节数、类风湿因子、血沉、C反应蛋白及DAS28等指标呈正相关(P<0.05),抗CCP抗体治疗前与双手X线分期相关。结论 RA患者血清GPI抗原和抗CCP抗体均具有较高的敏感性,GPI抗原与RA的活动性密切相关,可作为评估病情活动的新指标,抗CCP抗体与RA骨侵蚀相关,而与疾病活动无相关。

Objective To investigate the clinical significance of serum glucose-6-phosphate （GPI） and anti-cyclic citrullinated peptide （CCP） antibody in rheumatoid arthritis （RA）. Methods Sera from 41 patients with active RA and 30 healthy controls were analyzed. Levels of GPI and anti-CCP antibody were measured by enzyme linked immunosorbent assay （ELISA） in prior treatment and after 12 and 24 weeks of therapy. Analyze the correlations between levels of GPI and anti-CCP antibody and clinical variables. Results The diagnosis using the level of serum GPI and anti-CCP antibody exhibited the greatest diagnostic sensitivity for RA;they achieved 87.8% and 90. 2% , respectively and have no statistical significance. The level of serum GP1 and anti-CCP antibody in patients with RA of prior treatment were （3.33± 1.88）μg/ml and （84. 10±36. 26）U/ml. Both of them were significantly higher than those in normal controls （ P 〈 0. 001 ）. The level of serum GPI showed significantly decrease after 12 and 24 weeks of therapy than prior treatment（P 〈0. 001 ） in RA patients, but that not in anti-CCP antibody （P 〉 0. 05）. During prior or post treatment in patients with RA, GPI showed correlations to the RA patient＇s age,tender joint count, swollen joint count,serum RF titer,ESR, CRP and DAS28 score （ P 〈 0. 05 ）. Anti-CCP antibodies showed correlations to X-rays of hand joints in patients with RA of prior treatment. Conclusions Both GPI and Anti-CCP antibodies have high RA diagnostic sensitivity. GPI intimately correlated with disease activity of RA and may become a new index to evaluate disease activity. Anti-CCP antibody correlated with X-rays of hand joints in RA patients, but not correlation with disease activity.