血清抗环瓜氨酸肽抗体水平对幼年特发性关节炎的诊断价值

Significance of serum anti-cyclic citrullinated peptide antibodies in diagnosis of juvenile idiopathic arthritis

目的探讨血清抗环瓜氨酸肽(anti-CCP)抗体对幼年特发性关节炎(JIA)的诊断价值。方法采用ELISA法对68例因不明原因发热和关节痛疑诊为JIA患儿进行血清anti-CCP抗体水平检测,并结合临床资料及相关实验室检查指标进行综合分析。结果 68例疑诊JIA患儿中,多关节型JIA 10例,全身型JIA 13例,少关节型JIA 8例,与附着点炎症相关的JIA 13例;其他风湿性疾病11例,血液与肿瘤疾病8例,感染性疾病5例。多关节型JIA患儿的血清anti-CCP水平显著高于全身型、少关节型和附着点炎症相关的JIA患儿,差异有统计学意义(P<0.05)。以血清anti-CCP抗体≥15.8 RU/mL为阳性阈值,根据受试者工作特征(ROC)曲线计算曲线下面积为0.80,其对多关节型JIA诊断的敏感度为80%,特异度为67.6%。多关节型JIA患儿血清anti-CCP水平与血清C反应蛋白水平呈正相关(r=0.764,P=0.017)。结论血清anti-CCP可作为临床诊断多关节型JIA的血清学指标之一,15.8 RU/mL是较为适宜的诊断界限值。

Objective To investigate the clinical significance of serum anti-cyclic citrullinated peptide （anti-CCP） antibodies in diagnosis of juvenile idiopathic arthritis （JIA）. Methods Serum anti-CCP antibodies of 68 children suspected of JIA with fever and arthritis of unknown causes were determined by ELISA, and comprehensive analysis was carried out with clinical data and related laboratory findings. Results Among the 68 children suspected of JIA, there were 10 cases of polyarticular JIA, 13 cases of systemic onset JIA, 8 cases of oligoarticular JIA and 13 cases of enthesitis related JIA. There were 11 cases of other rheumatoid diseases, 8 cases of neoplastic diseases of blood and 5 cases of infectious diseases. The serum anti-CCP level in children suspected of polyarticular JIA was significantly higher than those in children suspected of systemic onset JIA, oligoarticular JIA and enthesitis related JIA （P 〈 0.05）. With serum anti- CCP ≥ 15.8 RU/mL as the positive threshold value, the area under receiver operating characteristic curve was 0.80, and the sensitivity and specificity in diagnosis of polyarticular JIA were 80% and 67.6% respectively. The serum anti-CCP level was positively related to serum C-reaction protein level in children suspected of polyarticular JIA （ r = 0. 764, P = 0. 017）. Conclusion Serum anti-CCP can be used for the diagnosis of polyarticular JIA, and 15.8 RU/mL may be a suitable cut-off level.