抗核抗体和抗环瓜氨酸肽抗体在风湿性疾病中的应用

Application of ANA and anti-CCP antibody in rheumatic diseases

目的探讨抗核抗体(ANA)和抗环瓜氨酸肽(CCP)抗体在风湿性疾病中的敏感性及相关性。方法收集浏阳市人民医院2010年9月至2013年2月433例已确诊为风湿性疾病患者和60例健康体检人员的血清,采用间接免疫荧光试验(IIFA)检测ANA,判断荧光核型,免疫印迹试验(LIA)抗核抗体谱(ANAs)12项检测特异性抗体,胶体金法测定抗CCP抗体,并对结果进行相关分析。结果 (1)在433例风湿性疾病患者血清标本中,ANA核型阳性共258例,其中系统性红斑狼疮阳性率为83.03%(137/165),类风湿关节炎(RA)阳性率为26.85%(40/149),原发性干燥综合征阳性率为64.15%(34/53),混合结缔组织病阳性率为100.00%(20/20),多肌炎/皮肌炎阳性率为33.33%(8/24),进行性系统性硬化症阳性率为86.36%(19/22);健康对照组阳性率为0.00%。(2)抗双链DNA(ds-DNA)抗体、抗史密斯(Sm)抗体、抗核糖体P蛋白抗体(ARPA)、抗组蛋白抗体和核小体抗体阳性标本中均质型所占比例最高;抗尿嘧啶-1低相对分子质量核糖核蛋白(抗U1-nRNP)抗体、抗干燥综合征抗原A(SS-A)抗体、抗SS-B抗体阳性标本中,斑点型所占比例最高;抗硬皮病-70(Scl-70)抗体主要见于均质核仁混合型;抗组氨酰-tRNA合成酶(Jo-1)抗体阳性标本中,胞浆型所占比例最高;抗着丝点B(CENP B)抗体则全为着丝点阳性;(3)在175例IIFA-ANA阴性(IIFA-ANA-)标本中,LIA-ANAs阳性(LIA-ANAs+)1例;(4)433例风湿性疾病患者中,抗CCP抗体阳性82例,其中RA组阳性率为51.68%(77/149),非RA组阳性率为1.76%(5/284)。结论 ANAs中抗ds-DNA抗体、抗Jo-1抗体、抗CENP B抗体与ANA的荧光模式和风湿性疾病类型有一定关联;ANA核型以斑点型所占比例最高;IIFA-ANA-者检出LIA-ANAs+的可能性较小;抗CCP抗体对RA的诊断具有较好的灵敏度和特异性,是诊断RA的特异性血清学标志。

Objective To explore the sensitivity and correlation of the antinuclear antibodies（ANA） and anti-cyclic cit- rullinated peptide（anti-CCP） antibody in rheumatic diseases. Methods Serums of 60 health-examined individuals and 433 pa- tients with rheumatic diagnosed in the People＇s Hospital of Liuyang from September 2010 to February 2013 were collected. Indi- rect Immune Fluorescence Assay（IIFA） was used to detect ANA to determine the fluorescence patterns, Western blot （LIA） and the 12 items of anti-nuclear antibodies spectrum （ANAS） were adopted to detect specific antibody and the colloidal gold method was applied to detect the anti-CCP antibody. Correlation analysis was conducted on the detecting results. Results （ 1 ） In the 433 serum specimens of rheumatic diseases, the number of ANA nuclear positive was 258, thereinto the positive rate of systemic lupus erythematosus （SLE） was 83.03% （137/165）;the positive rate of rheumatoid arthritis （RA） was 26.85% （40/149）;the positive rate of primary sicca syndrome （PSS） was 64.15% （34/53） ;the positive rate of mixed connective tissue disease （MCTD） was 100% （20/ 20 ） ; the positive rate of polymyositis/dermatomyositis （PM/DM） was 33.33% （8/24） ; the positive rate of progressive aystemic scle- rosis （PSS） was 86.36% （19/22）. While the positive rate in normal control group was 0.00%. （2） The positive specimens of dou- ble-stranded DNA （ds-DNA） antibody, anti-Sm antibody, antiribosomal P protein antibody （ARPA）, anti-histone antibody and the nucleosome antibody had the highest proportion of homogeneous pattern;the positive specimens of anti-uracil-1 low molecular weight ribonucleoprotein （U 1-nRNP） antibody, anti-SS-A antibody and anti-SS-B antibody had the highest proportion of speckled pattern ; anti-scleroderma-70 （SCL-70） antibody was mainly seen in the homogeneous nucleolar mixed pattern; the positive speci- mens of anti-Jo-1 antibody had the highest proportion of cytoplasmic pattern ;anti-CENP B antibodies were all centromere positive. （3） In 175 specimens of negative IIFA-ANA （IIFA-A NA-）, Only 1 cases was positive LIA-A NAs （ LIA-A NAs~）. （4） In 433 patients with rheumatic diseases, 82 cases was with positive anti-CCP antibody, therein, the positive rate of RA group was 51.68% （77/ 149）, and the positive rate of non-RA group was 1.76 % （5/284）. Conclusion In the ANA antibodies spectral, the anti-ds-DNA antibody,anti-Jo-1 antibody,anti-CENP B antibody,and ANA fluorescence mode have some relevance to the type of rheumatic diseases. The highest proportion of the ANA nuclear types is speckled pattern. It is less likely to detect LIA-ANAs- from the pa- tients with IIFA-ANA-. Anti-CCP-antibody has good sensitivity and specificity of diagnosis of RA, and it is the specific serological mark for diagnosis of RA.