抗CCP、dsDNA、ssDNA抗体对未分化关节炎转归为RA和SLE的意义

Anti-cyclic citrullinated peptide antibody and anti-DNA antibody predict progression to rheumatoid arthritis and systemic lupus erythematosus

研究抗环瓜氨酸肽(CCP)抗体和抗DNA抗体对未分化关节炎(UA)转归为类风湿关节炎(RA)和系统性红斑狼疮(SLE)的预测意义。对200例UA患者应用ELISA法检测血清抗CCP抗体和抗DNA抗体,观察UA患者2年内的转归情况。发现:134.0%的UA患者发展成RA,15.0%的UA发展为SLE;2抗CCP抗体对UA发展为RA的敏感性、特异性、阳性预测值和阴性预测值分别是77.9%、97.7%、94.6%和89.6%;3抗dsDNA抗体联合抗ssDNA抗体对SLE的诊断敏感性为65.0%,显著高于单独检测抗dsDNA抗体,但阳性预测值低于后者;4研究发现抗ssDNA抗体阳性的RA患者中25%在2年内发生RA继发性干燥综合征。据此,抗CCP抗体能够预测RA,联合检测抗dsDNA抗体和抗ssDNA抗体可以提高对SLE的诊断敏感性,有助于SLE的早期诊断,对出现抗ssDNA抗体阳性的RA患者需要警惕出现继发性疾病的可能。

To investigate the value of auto-antibodies including anti-cyclic citrullinated peptide（CCP） antibody and anti-DNA antibody in rheumatoid arthritis （RA） and systemic lupus erythematosus, all antibodies were detected by ELISA method in 200 cases of undifferentiated arthritis （UA） followed up for 2 years. 34.0% of UA were developed to RA and 15.0% of UA were SLE. The sensitivity and specificity as well as PPV and NPV of anti-CCP antibody were 77.9%, 97.7%, 94.6% and 89.6%, respectively. The combination of anti-dsDNA antibody and anti-ssDNA antibody had a higher sensitivity but a lower PPV than that of anti-dsDNA antibody only. We found that 25 % of the cases with positive anti-ssDNA antibody developed to RA second- ary Sj6gren＇s syndrome. Anti-CCP antibody has a good sensitivity and specificity in diagnosing early RA. The combination of anti-dsDNA antibody and anti-ssDNA antibody has a higher sensitivity but lower PPV than anti-dsDNA antibody only in diag- nosing early SLE. The cases of RA with positive anti-ssDNA antibody may develop to secondary diseases such as Shigren＇s syndrome.