老年PMR抗MPO抗体、GPⅠb及抗CarP抗体检测意义

Significance of detecting anti-MPO antibody,GPⅠb and anti-CarP antibody in elderly PMR patients

目的 探讨老年风湿性多肌痛(polymyalgia rheumatica,PMR)血抗髓过氧化物酶(anti-myeloperoxidase,抗MPO)抗体、血小板糖蛋白Ⅰb(platelet glycoproteinⅠb,GPⅠb)及抗氨甲酰化蛋白(anti-carbamylated protein,抗CarP)抗体检测的临床意义。方法 选取2019年7月至2022年1月温州市人民医院风湿免疫科收治的65例老年PMR患者(年龄≥60岁)为观察组,65例非老年PMR患者(年龄<60岁)为对照组,两组均予以泼尼松15mg/d连续治疗4周,检测两组患者治疗前后PMR活动度评分(PMR activity score,PMR-AS)、C反应蛋白(C-reactive protein,CRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、抗MPO抗体、GPⅠb和抗CarP抗体的变化;各指标和PMR-AS间的相关性采用Pearson相关分析;绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析各指标对疾病活动程度判断的准确性。结果 治疗后两组患者的PMR-AS、CRP、ESR、抗MPO抗体、GPⅠb和抗CarP抗体水平及病例异常率均较治疗前明显下降(P<0.05),且观察组患者下降更显著(P<0.05);老年PMR患者的CRP、ESR、抗MPO抗体、GPⅠb和抗CarP抗体水平与PMR-AS均呈正相关(r=0.580、0.808、0.755、0.739、0.811,P均<0.001);CRP、ESR、抗MPO抗体、GPⅠb和抗CarP抗体对疾病活动度准确性判断的ROC曲线下面积(area under the curve,AUC)分别为0.753、0.811、0.830、0.856、0.887,诊断敏感度分别为62.50%、75.25%、65.50%、75.00%和79.50%,诊断特异性分别为75.25%、80.05%、82.55%、87.50%和90.05%。结论 血抗MPO抗体、GPⅠb和抗CarP抗体水平与老年PMR患者病情活动度呈正相关,泼尼松治疗后各指标水平值下降明显,有望成为老年PMR患者疾病活动情况和治疗效果的监测指标。

Objective To investigate the clinical significance of blood anti-myeloperoxidase(anti-MPO)antibody,platelet glycoproteinⅠb(GPⅠb)and anti-carbamylated protein(anti-CarP)antibody in elderly polymyalgia rheumatica(PMR).Methods 65 elderly PMR patients(age≥60 years)were included in observation group and 65 non-elderly PMR patients(age<60 years)were included in control group,the two groups were treated with prednisone 15mg/d for 4 weeks.The changes of PMR activity score(PMR-AS),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),anti-MPO antibody,GPⅠb and anti-CarP antibody were measured before and after treatment.Pearson correlation analysis was used to analyze the correlation between each index and PMR-AS.The receiver operating characteristic(ROC)curve was used to analyze the accuracy of each index to the degree of disease activity.Results After treatment,the levels and case abnormal rates of PMR-AS,CRP,ESR,anti-MPO antibody,GPⅠb and anti-CarP antibody in two groups were significantly lower than those before treatment(P<0.05),and the decrease was more significant in observation group(P<0.05).The levels of serum CRP,ESR,anti-MPO antibody,GPⅠb and anti-CarP antibody in elderly patients with PMR were positively correlated with PMR-AS(r=0.580,0.808,0.755,0.739,0.811,P<0.001).The ROC curve show that the area under the curve(AUC)of CRP,ESR,anti-MPO antibody,GPⅠb and anti-CarP antibody in judging the accuracy of disease activity were 0.753,0.811,0.830,0.856 and 0.887 respectively,where diagnostic sensitivity was 62.50%,75.25%,65.50%,75.00%and 79.50%respectively,and the diagnostic specificity was 75.25%,80.05%,82.55%,87.50%,90.05%respectively.Conclusion The levels of blood anti-MPO antibody,GPⅠb and anti-CarP antibody were positively correlated with the disease activity of elderly PMR patients,where the level decreased significantly after prednisone treatment,which are expected to become a monitoring index of disease activity and treatment effect of elderly PMR patients.