抗环瓜氨酸肽抗体对类风湿关节炎的诊断、治疗及预后的临床价值

Clinical value of anti-cyclic citrullinated peptides antibody in diagnosis,treatment and prognosis of rheumatoid arthritis

目的:探讨抗环瓜氨酸肽抗体(CCP)和类风湿因子(RF)联合检测对类风湿关节炎(RA)的诊断价值,并分析抗CCP抗体浓度与RA的预后判断、药物反应和骨质破坏的临床相关性。方法:采用酶联免疫吸附法(ELISA)和动态免疫散射比浊法分别检测480例RA患者和非RA患者血清中抗CCP抗体和RF。结果:抗CCP抗体对RA的敏感性和特异性分别为:83.0%、96.7%;RF对RA的敏感性和特异性分别为:76.0%、70.0%;二者联合检测,以抗CCP抗体阳性或RF阳性作为联合检测的阳性判定,以抗CCP抗体阴性且RF阴性作为联合检测的阴性判定,对RA的敏感性为87.0%,高于单独检测的敏感性;对RA的特异性为98.3%,高于单独检测的特异性。抗CCP抗体浓度在治疗前、治疗后3个月和治疗后6个月的RA患者间存在很大差异(P<0.05)。RA患者是否发生骨侵蚀,其抗CCP抗体浓度存在较大差异(P<0.05);而且关节损害越严重,其抗CCP抗体浓度越高(P<0.05);随着治疗的进行,抗CCP抗体浓度的下降幅度在各组间也存在明显差异(P<0.05)。结论:联合检测抗CCP抗体和RF能够明显提高RA的诊断和鉴别诊断。抗CCP抗体浓度可随治疗有效而发生改变,动态监测可以作为考察药物疗效的观察指标。同时,抗CCP抗体水平能反映RA患者骨侵蚀的程度,且骨破坏严重者,治疗效果差。

Objective： To investigate the diagnostic values of anti-cyclic citrullinated peptides antibody（ anti-CCP） and rheumatoid factor（ RF） in rheumatoid arthritis（ RA）,and analyse the clinical relevance of prognosis,drug reaction and bone destruction between anti-CCP and RA. Methods： Serum anti-CCP was detected by enzyme-linked immunosorbent assay（ ELISA）,and RF was detected by immune rate nephelometry. Results： The sensitivity and specificity of anti-CCP in RA were 83. 0% and 96. 7%,while the sensitivity and specificity of RF in RA were 76. 0% and 70. 0%. When joint detect anti-CCP and RF,with anti-CCP or RF positive as a positive determination,with anti-CCP and RF negative as a negative judgment,the combined sensitivity was 87. 0%,higher than that of detection alone. The combined specificity was 98. 3%,higher than that of single detection. There were big different concentrations of antiCCP among RA patients before treatment,three months after treatment and six months after treatment. There were significant differences between bone erosion and non-bone erosion in RA patients. And the more serious joint damage,the higher the concentrations of antiCCP. As for treatment,anti-CCP concentrations declined. Conclusion： Combined detection of anti-CCP and RF can significantly improve the diagnosis and differential diagnosis of RA. The concentration of anti-CCP can change with effective treatment,then dynamic monitoring can be used as study drug efficacy. At the same time,the level of anti-CCP in patients with RA can reflect the degree of bone erosion,and serious bone destruction who was poor treatment effect.