抗瓜氨酸化蛋白／肽抗体及类风湿因子在类风湿关节炎早期诊断中的应用.pdf

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1、212TianjinMedJ，Mar2012，Vol40No3doi：10．3969~．issn．0253—9896．2012．03．007抗瓜氨酸化蛋白／肽抗体及类风湿因子在类风湿关节炎早期诊断中的应用王毅白雪张凯韩伟桐白人骁摘要目的：探讨两种抗瓜氨酸化蛋8／肽抗体(ACPA)即第三代抗环瓜氨酸肽(CCP3)抗体、抗突变型瓜氨酸波形蛋白(MCV)抗体及类风湿因子(RF)在类风湿关节炎(RA)诊断中的价值。方法：检测30例早期RA患者(RA组)、32例骨性关节炎(OA)和强直性脊柱炎(AS)患者(OA和As组)及3O例健康体检者(对照组)血清抗MCV抗体、抗CC

2、P3抗体及RF水平。分析3种抗体、疾病活动评分(DAS28)、红细胞沉降率(血沉，ESR)及c反应蛋白(CRP)在RA患者治疗后水平的变化。结果：RA组3种抗体的阳性率均高于对照组及OA和As组(P<0．O1)。抗MCV抗体、抗CCP3抗体及RF对RA诊断的敏感性分别为76．67％、66．67％、63．33％，特异性分别为96．77％、95．16％、83．87％。RF与抗MCV抗体、抗MCV抗体与抗CCP3抗体联合检测对RA诊断的敏感性为83．33％、80．00％。RA患者DAS28、ESR、CRP、抗MCV抗体及RF水平较治疗前降低(P

3、)。结论：抗MCV抗体对RA早期诊断价值较高。抗体联合检测提高了诊断的敏感性。抗MCV抗体及RF对判断RA疾病活动性有重要意义。3种抗体均具有鉴别RA与OA、AS的价值。关键词关节炎，类风湿类风湿因子抗瓜氨酸蛋白抗体抗环瓜氨酸肽早期诊断血沉C反应蛋白质TheClinicalValuesofACPAandRFforEarlyDiagnosisofRheumatoidArthritisWANGYi，BAIXue，ZHANGKai，HANWeitong，BAIRenxiaoCol~geofPreclinicalMedicineofTianjinMedicalUnive

4、rsity,死0njin300070．ChinaAbstractObjective：Toevaluateclinicalvaluesoftwokindsofantibodiesagainstcitrullinatedproteins／peptides(AC—PA)，third-generationanti-cycliccitrullinatedpeptides(anti-CCP3)，anti—mutatedcitrullinatedvimentin(anti—MCV)andrheumatoidfactor(RF1for山eearlydiagnosisofrheu

5、matoidarthritis(RA)．Methods：Theserumlevelsofanti—MCV，an—ti-CCP3andRFweredetectedin30patientswithearlyRA(RAgroup)，32patientswithosteoarthritis(OA)andankylosingspondylitis(AS)(OMASgroup)and30healthypemons(controlgroup)．，I’}lelevelsof3kindsofantibodies，DAS28scores，erythrocytesedimentati

6、onrate(ESR1andC—reactiveprotein(CRP)weredeterminedinRApatientsaftertreatment．Results：ThepositiveratesofthreeantibodiesweresignificantlyhigherinRAgroupthanthoseofcontrolgroupandOMASgroup，re—spectivelyfP<0．01)．Thesensitivitiesfordiagnosisofanti—MCV，anti—CCP3andRFwere76．67％，66．67％and63．

7、33％，andthespecificitieswere96．77％，95．16％and83．87％，respectively．rhesensitivityofperformingcombinationsofRFandan—ti—MCVtestswas83．33％．whilethesensitivityofperformingcombinationsofanti—MCVandanti—CCP3testswas80．O0％．ThelevelsofDAS28，ESR，CRP，anti—MCVandRFwereloweraftertreatmentinpatientsw

8、ithRA(尸<0．05