天津医药

• 论著 •    

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   

  1. 天津市天津医院
  • 收稿日期:2011-06-30 修回日期:2011-10-14 出版日期:2012-03-15 发布日期:2012-03-15
  • 通讯作者: 王毅

The clinical values of two kinds of ACPA and RF for early diagnosis of RA

Yi Wang   

  • Received:2011-06-30 Revised:2011-10-14 Published:2012-03-15 Online:2012-03-15
  • Contact: Yi Wang

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摘要： 【摘要】目的 探讨两种抗瓜氨酸化蛋白/肽抗体(antibodies against citrullinated proteins/peptides, ACPA)：第三代抗环瓜氨酸肽(cyclic citrullinated peptides, CCP)抗体、抗突变型瓜氨酸波形蛋白（mutated citrullinated vimentin, MCV）抗体及类风湿因子（rheumatoid factor, RF)在早期类风湿性关节炎(rheumatoid arthritis, RA)中的应用价值。方法 选择早期RA患者30例（早期RA组）；骨性关节炎（osteoarthritis, OA）和强直性脊柱炎（ankylosing sporidylitis, AS）患者共32例（OA和AS组）；健康体检者30例（健康对照组）。检测所有研究对象血清中抗MCV抗体、抗CCP3抗体及RF水平。评价三种抗体对早期RA的诊断性能。比较早期RA患者治疗后检测指标的水平变化。结果 当以RF≥30 IU/mL、抗CCP3抗体＞12 RU/mL、抗MCV抗体≥20 U/mL为RA诊断的阈值时，抗MCV抗体对早期RA的诊断性能最高，其敏感性为76.67%，特异性为96.77%，准确性为90.22%。RF与抗MCV抗体联合检测对早期RA诊断的敏感性为83.33%、抗MCV抗体与抗CCP3抗体联合检测敏感性为80.00%。早期RA组抗MCV抗体、抗CCP3抗体及RF的阳性率均高于健康对照组及OA和AS组（P＜0.01），而健康对照组与OA和AS组差异无统计学意义（P＞0.05）。早期RA患者治疗后DAS28、ESR及CRP水平均较治疗前降低（P＜0.01），抗MCV抗体及RF水平降低（P＜0.05）。结论 抗MCV抗体对早期RA具有较高的诊断价值。RF与抗MCV抗体、抗MCV抗体与抗CCP3抗体联合检测，提高了早期诊断的敏感性。抗MCV抗体、抗CCP3抗体及RF均具有鉴别RA与OA、AS的价值。抗MCV抗体及RF对RA患者的疗效评估及活动性判断具有重要意义。

关键词: 类风湿性关节炎, ACPA, 类风湿因子, 诊断, 活动性

Abstract: 【Abstract】Objective To evaluate the clinical values of two kinds of antibodies against citrullinated proteins/peptides, third-generation anti-cyclic citrullinated peptides (anti-CCP-3) and anti-mutated citrullinated vimentin (anti-MCV), and rheumatoid factor (RF) to early diagnosis of rheumatoid arthritis (RA). Methods Thirty Patients with early RA served as early RA group, 32 patients with osteoarthritis (OA) and ankylosing sporidylitis (AS) served as OA/AS group, and 30 healthy persons served as control group. The levels of anti-MCV, anti-CCP-3 and RF were determined. Results While RF≥30 IU/mL, anti-CCP-3＞12 RU/mL, anti-MCV≥20 U/mL served as the cut-off value for RA, anti-MCV tended to have the highest predictive value for RA, and the sensitivity of anti-MCV was 76.67%, the specificity of anti-MCV was 96.77%, and the accuracy of anti-MCV was 90.22%. The sensitivity of performing combinations of RF and anti-MCV tests was 83.33%, while the sensitivity of performing combinations of anti-MCV and anti-CCP-3 tests was 80.00%. The presences of anti-MCV, anti-CCP-3 and RF in early RA group were significantly higher than control group and OA/AS group respectively (P＜0.01), while the presences of anti-MCV, anti-CCP-3 and RF had no significant differences between control group and OA/AS group (P> 0.05). The levels of DAS28, ESR and CRP were lower after treatment in patients with RA (P＜0.01), while the levels of anti-MCV and RF were lower after treatment in patients with RA (P＜0.05). Conclusions Anti-MCV antibodies are valuable to early diagnosis of RA. Performing combinations of RF and anti-MCV tests and performing combinations of anti-MCV and anti-CCP-3 tests can increase the sensitivity of early diagnosis. Anti-MCV, anti-CCP-3 and RF can differentiate RA, OA and AS. Anti-MCV and RF are valuable for effect evaluation and activity evaluating in patients with RA.

Key words: rheumatoid arthritis, ACPA, rheumatoid factor, diagnosis, activity