早期类风湿性关节炎患者血清Ⅰ型胶原吡啶交联终肽、基质金属酶-3等指标的检测及意义

Detection and significance of serum cross-linked carboxyterminal telopeptide region of type Ⅰ collagen and matrix metalloproteinase enzyme-3 in patients with early rheumatoid arthritis

目的探讨Ⅰ型胶原吡啶交联终肽(ICTP)、基质金属酶-3(MMP-3)、抗环瓜氨酸肽(CCP)抗体、类风湿因子(RF)检测及类风湿性关节炎(RA)活动度在RA早期诊断中的意义。方法应用酶联免疫吸附试验(ELISA)检测213例RA患者(早期RA组92例、中长期RA组121例)、43例非RA的其他免疫系统疾病患者和40名正常对照者血清ICTP、MMP-3及抗CCP抗体;同时采用免疫比浊法检测血清RF。结果 ICTP、MMP-3、抗-CCP抗体、RF在早期RA诊断中的最佳临界值分别为3.21μg/L、67.45 ng/mL、15.45 U/mL、12.35 U/mL,灵敏度分别为74.0%、63.4%、52.4%、55.3%,特异性为95.5%、81.8%、95.5%、90.9%。RA各组RF、抗CCP水平均高于对照组及非RA组(P<0.01),ICTP、MMP-3、RF在非RA组和正常对照组间差异有统计学意义(P<0.01),ICTP在早期RA与非RA组间差异无统计学意义(P>0.05)。X线分期中Ⅰ期患者的ICTP、MMP-3、抗CCP抗体及RF水平与Ⅱ、Ⅲ期、Ⅳ期患者比较差异均有统计学意义(P<0.05、P<0.01)。Ⅱ期患者ICTP、MMP-3及抗CCP抗体水平与Ⅲ、Ⅳ期比较差异均有统计学意义(P<0.05、P<0.01),而RF水平3组之间差异无统计学意义(P>0.05)。结论同时检测ICTP、MMP-3、抗CCP抗体和RF能提高RA早期诊断的准确性,减少漏诊,动态联合检测可有效监测RA病情进展。

Objective To investigate the significance of cross-linked carboxyterminal telopeptide region of type Ⅰ collagen （ICTP）, matrix metalloproteinase-3 （MMP-3）, anti-cyclic citrullinated peptide （CCP） antibody, rheumatoid factor （RF） and rheumatoid arthritis （RA） activity in the early diagnosis of RA. Methods The enzyme-linked immunosorbent assay（ELISA） was used to determine the serum samples of 213 patients with RA （early RA group： 92 cases and medium-and long-term RA group： 121 cases） , 43 patients with non-RA associated and immune diseases and 40 healthy controls. The serum ICTP, MMP-3 and anti-CCP antibody were determined. The serum RF was determined by immunoturbidimetry. Results The optimal cut-off values of ICTP, MMP-3 and anti-CCP antibody in the diagnosis of early RA were 3.21 μg/L, 67.45 ng/mL, 15.45 U/mL and 12.35 U/mL. The sensitivities were 74.0% ,63.4%, 52.4% and 55.3%, and the specificities were 95.5%, 81.8%, 95.5% and 90.9%. RF and anti-CCP antibody were higher in the RA group than in the healthy control group and the non-RA group （ P 〈 0.01 ）. ICTP, MMP-3 and RF in the non-RA group and the healthy control group had statistical significance （ P 〈0.01 ）. ICTP in early RA and non-RA group had no statistical significance （P 〉 0.05）. The ICTP, MMP-3, anti-CCP antibody and RF of X ray staging Phase I had statistical significanees with those staging Phase Ⅱ , Ⅲand Ⅳ （ P 〈 0.05, P 〈 0. 01 ）. The ICTP, MMP-3 and anti-CCP antibody of Phase Ⅱwith those of Phase Ⅲ and Ⅳ had statistical significance （ P 〈 0.05, P 〈 0.01 ）. The RF among Phase Ⅱ ,Ⅲ and Ⅳ had no statistical significance （ P 〉 0.05 ）. Conclusions The simultaneous detection of ICTP, MMP-3, anti-CCP antibody and RF can improve accuracy and reduce missed diagnosis. Dynamic combination detection can monitor effectively the progression of RA.