【摘要】 目的:探讨抗环瓜氨酸肽(CCP)抗体对类风湿关节炎(RA)的诊断意义及与RA影像学病情进展的关系,并了解抗CCP抗体与IgM型类风湿因子(IgM-RF)、抗角蛋白抗体(AKA)、抗核周因子(APF)及HLA-DRB1*04等位基因的相关性。方法:酶联免疫吸附测定(ELISA)法检测39例RA、32例非RA病例及30名正常人血清的抗CCP抗体;对RA患者X线双手相进行2~9年随访,按照RA的Ste inbrocker疾病分期将X线病情进展分为I、II、III和IV期,观察下列因素对RA病情进展有否影响:性别、发病年龄、病程、起病关节、关节外表现、抗CCP抗体、IgM-RF、ANA、AKA、APF、抗RA33抗体及HLA-DRB1*04等位基因等。结果:抗CCP抗体对RA诊断的敏感性为84.6%,特异性为96.8%,阳性预测值为94.3%,阴性预测值为91.0%。抗CCP抗体与IgM-RF、AKA、APF及HLA-DRB1*04的相关性无统计学意义;Logistic回归分析显示只有HLA-DRB1*04等位基因对RA影像学病情进展具有显著性意义(P=0.044,回归系数r=0.206,期望值Exp=8.256),未发现抗CCP抗体与RA骨侵蚀进展具有相关性。结论:抗CCP抗体可作为RA良好的诊断指标;抗CCP抗体对RA病情严重性及预后判定的意义有待进一步探讨。更多还原

【Abstract】 Objective:To explore the diagnostic significance of anti-cyclic citrullinated peptide antibody(anti-CCP) and its predictive value for radiological progression in patients with rheumatoid arthritis(RA) and investigate the association of anti-CCP with IgM-rheumatoid factor(IgM-RF),anti-keratin antibodies(AKA),antiperinuclear factor(APF),and human leukocyte antigen(HLA)-DRB1 alleles.Methods:Anti-CCP was tested by an enzyme-linked immunosorbent assay(ELISA) in serum samples from 39 patients with RA,33 nonRA controls with various rheumatic diseases and 30 healthy individuals,and the diagnostic significance of anti-CCP was evaluated.Thirty-nine RA cases had taken hand X-ray photography in every 1~2 years and been followed up for 2~9 years.Logistic regression was used to analyze the factors which may impact the radiological progression of RA,such as sex,age of onset,disease duration,the joint onset,extra-articular involvements,anti-CCP,IgM-RF,ANA,AKA,APF,anti-RA33 antibodies and HLA-DRB1*04 alleles.Results:The diagnostic sensitivity and specificity of anti-CCP were 84.6%,96.8%,respectively.No significant association was found between anti-CCP and IgM-RF,AKA,APF or HLA-DRB1 alleles.The follow-up study showed that only HLA-DRB1*04 alleles were significantly associated with the radiological progression of RA(P=0.044,r=0.206,Exp=8.256),and no significant association was found between anti-CCP and erosive disease.Conclusion:Anti-CCP is a valuable diagnostic marker for RA.No significant association is found between anti-CCP and the radiological progression of RA.更多还原