手腕部MRI联合抗环瓜氨酸肽抗体检测在早期RA诊断中的应用价值

Application of wrist MRI combined anti-cyclic citrullinated peptide antibody detection in the diagnosis of early rheumatoid arthritis

目的 探讨手腕部MRI联合抗环瓜氨酸肽抗体（抗-CCP抗体）检测在早期类风湿性关节炎（RA）诊断中的应用价值.方法 选取本院风湿免疫科早期RA患者45例作为RA组,非RA患者45例作为非RA组,健康体检者43例作为对照组,全部行手腕部MRI检查并采用ELISA方法检测抗-CCP抗体,同时搜集患者临床症状、体征、实验室指标及MRI表现,对结果进行统计学分析.结果 RA组患者MRI阳性率和血清抗-CCP抗体阳性率明显高于非RA组和对照组,差异具有统计学意义（P＜0.05）;MRI与抗-CCP抗体对早期RA的灵敏度和特异度分别是88.88％和68.88％、82.22％和91.11％,两者联合检测灵敏度（64.44％）较单独检测有所降低,但特异度高达100％;MRI滑膜评分分值与抗-CCP抗体水平呈正相关（rs=0.612,P＜0.05）;MRI异常征象与关节疾病活动性评分（DAS28）呈正相关（rs=0.521,P＜0.05）,抗-CCP抗体阳性率与DAS28呈正相关（rs=0.541,P＜0.05）.结论 MRI和抗-CCP抗体联合检测可提高RA早期诊断的准确性,亦为动态评估RA病情变化提供了检测依据.

Objective To study the clinical value of wrist magnetic resonance imaging （MRI） combined anti-cyclic citrullinated peptide antibody detection in the diagnosis of early rheumatoid arthritis （RA）.Methods Forty five patients with early RA were selected as RA group,45 cases of patients without rheumatoid arthritis as non-RA group,and 43 cases of people with normal examination as control group.All subjects were given wrist MRI and anti-cyclic citrullinated peptide （CCP） antibody with the enzyme linked immunosorbent assay （ELISA）.At the same time,clinical symptoms,physical signs,MRI manifestations,and laboratory indicators were collected.All results were statistically analyzed.Results Positive rate of MRI lesions and serum anti-CCP antibody in RA group were significantly higher than non-RA group and control group （P 〈0.05）.The sensitivity and specificity of MRI （or anti-CCP antibody） for early RA were 88.88% and 82.22% （or 68.88% and 91.11%）.The sensitivity （64.44%） of MRI combined with anti-CCP antibody was decreased compared to individual; however,the specificity （100%） of MRI combined with anti-CCP antibody was increased.The correlation of MRI synovial scores and anti-CCP antibody levels was positively correlated （rs =0.612,P 〈 0.05）.MRI abnormal signs and joint disease activity score （DAS28） were positively correlated （rs =0.521,P 〈 0.05）.Anti-CCP antibody levels and DAS28 were positively correlated （rs =0.541,P 〈 0.05）.Conclusions MRI examination and combined with anti-CCP antibody detection is helpful to improve the diagnosis of early RA,and it provides a detection basis for dynamic assessment of RA condition changes.