抗CCP抗体对老年起病类风湿关节炎诊断及预后评估的临床价值

Clinical value of the anti-cyclic Citrullinated peptide Antibody in the diagnosis and Prognosis Evaluation of elderly-onset Rheumatoid Arthritis

目的:探讨抗环瓜氨酸肽(CCP)抗体对老年起病类风湿关节炎(EORA)诊断和预后评估的临床应用价值。方法:收集2010年3月至2011年3月在上海市第一人民医院分院风湿科门诊及住院治疗的EORA患者98例,骨性关节炎(OA)患者30例,风湿性多肌痛(PMA)患者10例,其他结缔组织病30例,正常老年健康对照48例,应用酶联免疫吸附法检测所有患者血清抗CCP抗体水平,并检测其IgM型类风湿因子(IgM-RF)。计算抗CCP抗体、IgM-RF及联合检测两者诊断EORA的特异度、敏感度、阳性预测值、阴性预测值。同时记录EORA患者的临床资料,分析抗CCP抗体阴性和阳性患者中年龄、性别、疾病活动指数28(DAS28)、ESR、CRP、骨损害的变化,对其预后进行预测。结果:EORA患者抗CCP抗体和IgM-RF的阳性率均明显高于其他结缔组织病患者和健康对照人群,差异均有统计学意义(P<0.05)。抗CCP抗体对EORA诊断的敏感性略低于IgM-RF,但特异性明显提高,差异均有统计学意义(P<0.05)。抗CCP抗体及IgM-RF对EORA诊断的敏感性和特异性分别为:61.2%、75.5%和97.1%、62.9%,两者联合检测的敏感性及特异性为:49%和98.5%。差异均有统计学意义(P<0.05)。抗CCP抗体阳性患者和阴性患者比较,年龄、性别、病程、ESR、CRP水平的差异均无统计学意义(P>0.05),但抗CCP抗体水平与DAS28评分呈正相关(P<0.05),与关节x线分期无明显相关性(P>0.05)。但抗CCP抗体阳性患者,更易出现骨损害,预后较差。结论:抗CCP抗体对诊断EORA具有较高的临床价值,且可以作为辅助预测和评价预后的指标。

Objective： To determine the clinical value of the anti-cyclic citrullinated peptide antibody（CCP） in the diagnosis and prognosis evaluation of elderly-onset rheumatoid arthritis（EORA）. Methods： A total of 98 patients with EORA, 30 patients with Osteoarthritis（OA）, 10 patients with Polymyalgia rheumatica（PMA） and 30 patients with other connective tissue disease were recruited in this study. Anti-CCP antibodies and IgM-rheumatoid factor were determined by ELISA according to manufacturer instructions, with a cut-off of 20u, The anti-CCP antibodies and erythrocyte sedimentation rate（ESR）, C reactive protein（CRP）, activity score 28（DAS28） and bone erosion was Assessed. Results： In the group of patients with EORA, the sensitivity and specificity of anti-ccp antibodies and IgM-RF were respectively 61.2%,75.5% and 97.1%,62.9%. The sensitivity and specificity of united-detection of anti-ccp antibodies and IgM-RF were 49% and 97.1%.The mean DAS28 score of EORA patients with anti-CCP positive was significantly higher than that of patients without anti-CCP. Among anti-CCP positive EORA patients, the mumber of patients with erosion disease was signficantly higher than the patients without anti-CCP and with worse prognosis. Conclusion： Anti-CCP antibodies was a higher specific autoantibody in the diagnosis of EORA and could be used as a prognostic indicator of prediction and evaluation of EORA.