类风湿关节炎患者外周血抗CCP抗体和免疫球蛋白检测的临床意义

Diagnostic implications of peripheral blood anti-CCP antibody and immunoglobulin levels for rheumatoid arthritis

目的:评价类风湿关节炎(rheumatoid arthritis,RA)患者外周血抗环瓜氨酸(cyclin citrullinated peptide,CCP)抗体、类风湿因子(rheumatoid factor,RF)、免疫球蛋白(IgM、IgA和IgG)水平在类风湿关节炎诊断中的作用。方法:收集97例RA患者外周血(活动期56例,静止期41例)及健康体检者50例外周血,评估RA患者关节疾病活动评分(disease activity score in 28joints,DAS28)指标数值,采用ELISA方法检测抗CCP抗体,免疫比浊法检测RF和三种免疫球蛋白水平。结果:活动期RA患者外周血RF、IgM和IgG的水平高于静止期RA患者和健康对照组(P<0.05),差异有统计学意义;静止期RA患者除类风湿因子高于健康对照组外(P<0.05),IgM、Ig A和IgG的水平均无统计学差异(P>0.05)。按抗CCP抗体和RF检测结果对RA患者进行分类后比较,CCP+RF+组IgG、IgM和DAS28水平最高,CCP+RF-组次之,其他两组间无统计学差异。结论:抗CCP抗体、IgG和IgM与RA患者病情活动度相关,抗CCP抗体阳性具有更加严重的致病性,联合检测可为临床提供个性化治疗的实验室依据。

Objective： To investigate the implications of determining the levels of peripheral blood anti-cyclin citrullinated peptide（ anti-CCP） antibody,rheumatoid factor,and IgM,IgG and Ig A for diagnosis of rheumatoid arthritis（ RA）.Methods： Peripheral blood was obtained from 97 patients with RA,including 56 of active RA and 41 of inactive RA,and another 50 healthy subjects undergoing physical examination as controls. Disease Activity Score（ DAS28） was used to quantitatively measure the disease activity,ELISA to determine the serum anti-CCP antibody concentration,and immunoturbidimetric assay was performed to measure RF and IgM,IgG and IgA levels.The clinical data on the patients were also collected.Results： RA patients in active disease had higher concentration of peripheral blood anti-CCP antibody as well as higher IgM and IgG levels than in inactive RA and in healthy controls（ P〈0.05）,whereas Ig M,Ig G and IgA levels were not significantly different in RA patients in inactive stage（ P〉0.05） except for higher RF levels than the controls（ P〈0.05）.By the results of anti-CCP antibody and RF,the levels of IgG,IgM and DAS28 scoring were highest in CCP ＋RF＋ group,followed by CCP ＋RF- group.No difference was found in another two groups.Conclusion： Levels of serum anti-CCP antibody,IgM and IgG are positively correlated with RA activity,and positive CCP antibody may indicate serious RA for patients. Importantly,integrated measurement of anti-CCP and immunoglobulin levels may provide laboratory evidence for RA patients on individualized therapy regimen.