抗瓜氨酸化蛋白／肽抗体及类风湿因子在类风湿关节炎早期诊断中的应用

The Clinical Values of ACPA and RF for Early Diagnosis of Rheumatoid Arthritis

目的:探讨两种抗瓜氨酸化蛋白/肽抗体(ACPA)即第三代抗环瓜氨酸肽(CCP3)抗体、抗突变型瓜氨酸波形蛋白(MCV)抗体及类风湿因子(RF)在类风湿关节炎(RA)诊断中的价值。方法:检测30例早期RA患者(RA组)、32例骨性关节炎(OA)和强直性脊柱炎(AS)患者(OA和AS组)及30例健康体检者(对照组)血清抗MCV抗体、抗CCP3抗体及RF水平。分析3种抗体、疾病活动评分(DAS28)、红细胞沉降率(血沉,ESR)及C反应蛋白(CRP)在RA患者治疗后水平的变化。结果:RA组3种抗体的阳性率均高于对照组及OA和AS组(P<0.01)。抗MCV抗体、抗CCP3抗体及RF对RA诊断的敏感性分别为76.67%、66.67%、63.33%,特异性分别为96.77%、95.16%、83.87%。RF与抗MCV抗体、抗MCV抗体与抗CCP3抗体联合检测对RA诊断的敏感性为83.33%、80.00%。RA患者DAS28、ESR、CRP、抗MCV抗体及RF水平较治疗前降低(P<0.05或P<0.01)。结论:抗MCV抗体对RA早期诊断价值较高。抗体联合检测提高了诊断的敏感性。抗MCV抗体及RF对判断RA疾病活动性有重要意义。3种抗体均具有鉴别RA与OA、AS的价值。

Objective： To evaluate clinical values of two kinds of antibodies against citrullinated proteins/peptides （ACPA）, third-generation anti-cyclic citrullinated peptides （anti-CCP3）, anti-mutated citrullinated vimentin （anti-MCV） and rheumatoid factor （RF） for the early diagnosis of rheumatoid arthritis （RA）. Methods： The serum levels of anti-MCV, anti-CCP3 and RF were detected in 30 patients with early RA （RA group）, 32 patients with osteoarthritis （OA） and ankylosing spondylitis （AS） （OA/AS group） and 30 healthy persons （control group）. The levels of 3 kinds of antibodies, DAS28 scores, erythrocyte sedimentation？rate （ESR） and C-reactive protein （CRP） were determined in RA patients after treatment. Results： The positive rates of three antibodies were significantly higher in RA group than those of control group and OA/AS group, respectively （P 〈 0.01）.The sensitivities for diagnosis of anti-MCV, anti-CCP3 and RF were 76.67%, 66.67% and 63.33%, and the specificities were 96.77%, 95.16% and 83.87%, respectively. The sensitivity of performing combinations of RF and anti-MCV tests was 83.33%, while the sensitivity of performing combinations of anti-MCV and anti-CCP3 tests was 80.00%. The levels of DAS28, ESR, CRP, anti-MCV and RF were lower after treatment in patients with RA （P 〈 0.05 or P 〈 0.01）. Conclusion： The anti-MCV antibody is valuable for early diagnosis of RA. The sensitivity of early diagnosis is increased using combined antibody tests. There was an important significance in diagnosis of RA using anti-MCV and RF. Three kinds of antibodies are valuable for differentiating of RA from OA and AS.