抗环瓜氨酸肽抗体对不同发病年龄类风湿关节炎的早期诊断价值

Early diagnostic value of anti-cyclic citrullinated peptide antibody among different age groups in rheumatoid arthritis

目的探讨抗环瓜氨酸肽(CCP)抗体检测对不同发病年龄类风湿关节炎(RA)的早期诊断价值。方法选择2011年1月至2012年6月收治的RA患者345例,按发病年龄分为老年组(60岁以后发病)75例、成年组(16～60岁发病)246例、幼年组(16岁以前发病)24例,应用罗氏E170化学发光仪和电化学发光法对三组患者进行抗CCP抗体定量检测,并与类风湿因子(RF)比较。结果老年组、成年组和幼年组患者抗CCP抗体阳性率分别为42.67%(32/75)、37.80%(93/246)、8.33%(2/24)。各组间抗CCP抗体阳性率存在差异。老年组和成年组分别与幼年组抗CCP抗体、RF阳性率比较,差异均有统计学意义(P<0.01);同组间抗CCP抗体与RF阳性率呈显著正相关;老年组和成年组患者抗CCP抗体、RF阳性率与其红细胞沉降率(ESR)、C-反应蛋白(CRP)呈正相关,但在幼年组差异无统计学意义(P>0.05)。结论在老年组和成年组RA患者中联合检测抗CCP抗体与RF更有价值。虽然抗CCP抗体不能作为诊断幼年类风湿关节炎的主要依据,但可作为其关节损伤严重程度的指标。

Objective To investigate the clinical value of anti-cyclic citrullinated peptide （CCP） antibody in the early diagnosis of rheumatoid arthritis （RA） with different onset ages. Methods 345 cases of RA in the rheumatism clinic and the in patients department from January 2011 to June 2012 were selected and divided into 3 groups according to the onset age, the elderly group（onset age 〉60 years ,75 cases） ,adult group（onset age 16-60 years ,246 cases） and young adult group（onset age〈16 years, 24 cases）. Anti-CCP antibody expression levels were detected by the electrochemical luminescence method and compared with the rheumatoid factor （RF） expression levels. Results The positive rates of anti-CCP antibody in the elderly, adult, young adult groups were 42.67% （32/75）, 37.80% （93/246） and 8.33% （2/24） respectively. The difference in the positive rate of anti-CCP antibody and RF existed among different age groups. Comparing the elderly and adult groups with the young adult group showed that the positive rate of anti-CCP antibody and RF had statistical difference （P〈0.01）. In the same group, anti-CCP antibody and the positive rate of RA demonstrated the obviously positive correlation. Anti-CCP antibody and the positive rate of RF in the elderly and adult groups were positively correlated with ESR and CRP, but differenc in the young adult group had no statistical difference. Conclusion The combined detection of anti-CCP antibody and RF is more valuable in the elderly and adult RA patients. Although anti-CCP antibody could not serve as the main basis for the diagnosis of juvenile rheumatoid arthritis （JRA）, but can be used as an indicator of the severity of joint damage in JRA.