作者:曲世晶叶华贾汝琳栗占国
[摘要]目的:检测血清学阴性类风湿关节炎患者的关节液中抗环瓜氨酸肽抗体、抗突变型瓜氨酸波形蛋白抗体水平,了解关节液中这两种抗体对诊断的临床意义。
方法:应用酶联免疫吸附测定法检测两组患者膝关节液中抗CCP抗体和抗MCV抗体,实验组为SNRA患者,共29例,对照组为骨关节炎患者,共28例,并收集两组患者的临床表现及实验室指标。
结果:实验组29例SNRA患者膝关节液中抗CCP抗体阳性者10例(34.5%),测定值为(.5±62.6)U/ml;抗MCV抗体阳性者6例(20.7%),测定值为(32.0±11.3)U/ml;对照组28例OA患者膝关节液3例抗CC±P抗体阳性(10.7%),测定值为(20.6+0.1)U/ml,2例抗MCV抗体阳性(7.2%,)测定值为(22.11.7)U/ml%。SNRA组组关节液抗CCP抗体的阳性率显著高于对照组(34.5%vs10.7%,X2=4.,P0.05);SNRA组关节液抗MCV抗体的阳性率高于对照组(20.7%vs7.1%,X2=2.,P0.05),但差异无统计学意义;抗CCP抗体在SNRA中的敏感性为34.5%,特异性为89.3%,阳性预测值76.9%,阴性预测值为56.8%;抗MCV抗体敏感性20.7特异性为92.9%,阳性预测值为75.0%,阴性预测值为53.1%;膝关节液中抗CCP抗体和抗MCV抗体两者联合检测的敏感性为48.0%,特异性为82.8%,SNRA关节液抗CCP抗体阳性组、抗MCV抗体阳性组与各自阴性组相比较,在年龄、病程和晨僵方面差异均无统计学意义,而膝关节液抗CCP抗体阳性组和抗MCV抗体阳性组红细胞沉降率、C反应蛋白和28个关节的疾病活动评分均比各自阴性组高(P均0.01)抗CCP抗体与ESR和CRP与之间呈正相关(r=0.,P0.01;r=0.,P0.01),抗MCV抗体与ESR和CRP之间呈正相关(r=0.,P0.01;r=0.,P0.01)。
结论:SNRA关节液抗CCP抗体和抗MCV抗体联合检测有助于SNRA诊断和疾病活动的判断。
[关键词]关节炎,血清,类风湿因子,抗环瓜氨酸肽抗体,抗突变型瓜氨酸波形蛋白,滑液
附原文:
Abstract
OBJECTIVE:
Toexplorethesignificanceofsynovialfluid(SF)anti-cycliccitrullinatedpeptide(CCP)antibodiesandanti-mutatedcitrullinatedvimentin(MCV)antibodiesinthediagnosisofserumnegativerheumatoidarthritis(SNRA).
[ArticleinChinese]
QuSJ1,YeH2,JiaRL2,LiZG2.
METHODS:
Enzymelinkedimmunosorbentassay(ELISA)methodwasaplliedinthedetectionoftwogroupsofpatientswithkneejointfluidresistanceagainstCCPantibodyandantibodyofMCV,theexperimentalgrouptoSNRApatients,atotalof29cases,andthecontrolforpatientswithosteoarthritis(OA),atotalof28cases,andclinicalmanifestationsandlaboratoryparametersofthetwogroupswerecollected.
RESULTS:
Thepositiverateofsynovialfluidanti-CCPwas34.5%intheSNRApatients,whichwassignificantlyhigherthan10.7%inthecontrolpatients(χ2=4.,P0.05).Thepositiverateofsynovialfluidanti-MCVwas20.7%intheSNRApatients,whichwassignificantlyhigherthan7.1%inthecontrolpatients(χ2=2.,P0.05).TheSNRApatientsofSFanti-CCPandanti-MCVpositivehadnosignificantdifferencefromtheSNRApatientsofSFanti-CCPandanti-MCVnegativeinage,courseandmorningstiffness.Thelevelsoferythrocytesedimentationrate(ESR),C-reactiveprotein(CRP)andDAS28scoresintheSFanti-CCPpositivepatientswerehigherthanthoseoftheSFanti-CCPnegativepatients.ThelevelsofESR,CRPandDAS28scoresintheSFanti-MCVpositivepatientswerehigherthanthoseoftheSFanti-MCVnegativepatients,(allP0.01).SFanti-CCPhadcorrelationwithESR,CRP(r=0.,P0.01;r=0.,P0.01).SFanti-MCVhadcorrelationwithESR,CRP(r=0.,P0.01;r=0.,P0.01).
CONCLUSION:
SFanti-CCPandanti-MCVarehelpfulforthediagnosisofSNRAandjudgementofSNRAactivity.
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