【作者】 杜娟；

【导师】 郭嘉隆；

【作者基本信息】 吉林大学 ， 内科学， 2009， 硕士

【摘要】 目的:本研究主要探讨抗环瓜氨酸肽抗体(抗CCP抗体)及其血清水平与早期类风湿关节炎(RA)的疾病活动度,骨侵蚀等临床指标的相关性。方法:收集97例早期RA患者年龄、性别、病程、肿胀关节数、压痛关节数、晨僵时间、红细胞沉降率(ESR)、类风湿因子(RF)、疾病活动性评分(DAS28)、双手及腕关节X线片等资料,测定抗CCP抗体、IgG-RF、IgM-RF、IgA-RF。结果:97例早期RA患者中,抗CCP抗体阳性60例(61.9%),RF阳性62例(63.9%);46例患者(47.4%)抗CCP抗体、RF均阳性,21例患者(21.6%)抗CCP抗体、RF均阴性。在RF阴性的RA患者中,抗CCP抗体阳性率为40%。抗CCP抗体阳性组患者肿胀关节数、压痛关节数明显多于阴性组(p=0.000和0.000);DAS28评分明显高于阴性组(p=0.000);晨僵时间、ESR在两组间的差异无统计学意义。血清抗CCP抗体水平与肿胀关节数、压痛关节数、DAS28评分、ESR呈正相关(r=0.726,p=0.000;r=0.647,p=0.000;r=0.714,p=0.000;r=0.294,p=0.003),与晨僵时间、血清IgG-RF、IgA-RF、IgM-RF不具有相关性。70例早期RA患者存在骨侵蚀,占72.2%,27例患者无骨侵蚀,占27.8%,抗CCP抗体阳性组患者X线出现骨侵蚀改变比率明显高于抗CCP抗体阴性组(p=0.000),在骨侵蚀组与非骨侵蚀组之间抗CCP抗体水平、ESR差异有统计学意义(p=0.000和0.004)。不同X线分期的血清抗CCP抗体水平差异有统计学意义(p<0.05)。结论:RA患者早期即可出现骨侵蚀破坏。早期RA患者抗CCP抗体及其血清水平与疾病活动度及骨侵蚀严重程度相关。ESR可提示骨侵蚀发生。更多还原

【Abstract】 RA is a systematic autoimmune disease with a cardinal manifestation of progressive articular inflammation. If sufferers don’t receive timely and proper treatments at early time, most of them will develop into joint damage and deformity and eventually lead to loss of function. In our country, the prevalence of RA is about 0.32% to 0.36%, which occurs mostly among women in adult, almost all patients will lose their joint functions to some extent. Some researches have shown that RA patients’joint functions reduce early, in one year after the onset, slight loss of function will happen. Imaging changes appear on the initial stage of RA. Clinical data indicate that irreversible arthritis appears in the first year of the onset of RA, bone destruction and joint space narrowing happen in two years. This kind of disease is described as“5D”in foreign countries, that is, discomfort, distress, disability, death and dollar lost. Therefore, patients should start therapy as early as possible. Doctors should give them effective disease-modifying anti-rheumatic drugs (DMARDs) in the early time, so that disease progression can be controlled, bone joint description can be prevented and reduced, which is especially important to ameliorate RA’s prognosis. Early diagnosis is the base of early therapy, while, the present standards of RA diagnosis depend mainly on clinical manifestation-ray inspection and rheumatoid factor (RF) inspection. While the following standards make against the early diagnosis of RA, such as, bone has been destructed when the check results meet the imaging standards, while the sensitivity of rheumatoid factor(RF)is 68%-81%,specific immunity of RF is 60%～85%,both the sensitivity and the specific immunity are poor, and in other autoimmune diseases such as Systemic Lupus Erythematosus (SLE) also have certain positive rate. In 2000,Schellekens used ELISA to inspect anti-cyclic citrullinated peptide antibody(anti-CCP antibody)in RA patients’ blood serum. After that, a lot of researches in foreign countries have shown that anti-CCP antibody have very high sensitivity and specific to RA. Through analyzing the related literatures in the databank of PUBMED, EMBASE, OVID and CNKI in five year, it is shown that the sensitivity and specific immunity of anti-CCP antibody for RA diagnosis are 77.3% and 93.85% respectively. Not only that, but anti-CCP antibody is better on diagnosing RA than RF. Anti-CCP antibody is of definiteness for improving the sensitivity of RA diagnosis especially RA’s early diagnosis which may have a high diagnostic value for RA diagnosis. Nowadays the researches on anti-CCP antibody mainly focused on its value for RA’s early diagnosis. Research between anti-CCP antibody and clinic is less, and the conclusions nowadays are not same. This research will study early RA patients by dividing groups according to current situation, further discuss the pertinence between anti-CCP antibody, blood serum level and RA’s disease activity, bone erosion’s clinical indices, then will discuss the relation between anti-CCP antibody and early RA’s clinical manifestation and its prognostic.97 RA early patients are included in this research. The patients’number of swelled joint, the number of painful joint, the duration time of morning stiffness, IgG-RF, IgM-RF, IgA-RF, anti-CCP antibody,erythrocyte sedimentation rate(ESR), rheumatoid factor(RF) DAS28 and imaging changes are noted respectively, determine the level of anti-CCP antibody,IgG-RF, IgM-RF, IgA-RF,then we analyze the changes of the above index of the patient whose anti-CCP antibody are found positive and negative, then further discuss the pertinence between anti-CCP antibody level in the patients’blood serum whose anti-CCP antibody are found positive and their above index. At the same time, the relation between IgG-RF, IgM-RF, IgA-RF, ESR and bone erosion will be studied.The results showed:1.72.2% of patients has evidence of radiographic progression within 2 years of disease onset; this prompted the early RA patients with high incidence of bone erosion.2. The number of swelled joint and the number of tender joint in the passive group are more obviously than in the negative group. DAS28 scores in passive group are higher obviously than in negative group. But the duration time of morning stiffness and ESR are not statistically significant between the two groups.3. The serum level of anti-CCP antibody is positive correlation with the number of swollen joint count, tender joint count, ESR and DAS28 scores, but there is no correlation with the duration time of morning stiffness, the serum level of IgG-RF, IgA-RF, and IgM-RF.4. Among anti-CCP antibody positive RA patients, the number of patients with erosive disease is statistically higher than anti-CCP antibody negative RA patients. However, the number of patients with erosive disease is not statistically different between RF-positive and RF-negative patients. The serum level of anti-CCP antibody and ESR is of statistical significance between patients with erosive disease and non-erosive disease.5.The difference of anti-CCP antibody level in blood serum in different x-ray periods (except periodⅣ) is of statistical significance, that is, periodⅡis higher than periodⅠ,periodⅢis higher than periodⅡ,is obvious through analysis of variance. Comparing the ESR of patients in periodⅡand periodⅢin x-ray inspection with that in periodⅠ, the difference has statistical significance, that is, the ESR of periodⅡand periodⅢpatients is obviously higher than those in periodⅠ,while comparing periodⅡand periodⅢ,the difference is of no statistical significance. The difference of IgG-RF、IgA-RF and IgM-RF in different x-ray periods is of no statistical significance.Conclusion:1. Bone destruction can occur in early RA.2. ESR can prompt the occurrence of bone erosion.3. Anti-CCP antibody and its blood serum level are of correlation with the degree of disease activity and severity degree of bone erosion.更多还原