CAJ | 학술논문

目的探讨类风湿因子(RF)、抗角蛋白抗体(AKA)、抗环瓜氨酸肽(CCP)抗体、抗核周因子(APF)4种自身抗体对未分化关节炎(UA)转化为类风湿关节炎(RA)的临床预测价值,并分析其临床相关因素.方法对271例UA患者随访1年,采用免疫比浊法检测RF,酶联免疫吸附试验(ELISA)检测抗CCP抗体,间接免疫荧光法(IIF)检测APF与AKA,魏氏法测定红细胞沉降率(ESR),记录患者的晨僵时间、关节肿胀数、关节压痛数、不同关节受累及DAS28评分.结果 4种抗体均阳性的UA患者转化为RA的阳性率为99%;任2种及2种以上抗体阳件的UA患者转化为RA的敏感性83.0%,特异性65.9%;RF/抗CCP抗体阳性的UA患者转化为RA的敏感性77.8%,特异性80.5%;抗体均阴性和任1、2、3种抗体阳性及4种抗体全阳性患者的多关节肿胀及多个小关节受累的比率分别为48%、57%、59%、70%、70%和71%、71%、72%、76%、82%;抗体阴性的UA患者中肘关节受累所占比例最大,为72%;多关节肿胀及多个小关节受累在UA转化为RA与无多关节肿胀及多个小关节受累的转化率最大.结论 4种抗体联合检测可提高RA早期诊断的特异性,阳性抗体越多.UA越容易发展为RA;RF/抗CCP抗体阳性的UA患者转化为RA的敏感性和特异性均较高.多关节肿胀和多个小关节受累对评估RA病情有重大意义.
목적 탐토류풍습인자(RF)、항각단백항체(AKA)、항배과안산태(CCP)항체、항핵주인자(APF)4충자신항체대미분화관절염(UA)전화위류풍습관절염(RA)적림상예측개치,병분석기림상상관인소.방법 대271례UA환자수방1년,채용면역비탁법검측RF,매련면역흡부시험(ELISA)검측항CCP항체,간접면역형광법(IIF)검측APF여AKA,위씨법측정홍세포침강솔(ESR),기록환자적신강시간、관절종창수、관절압통수、불동관절수루급DAS28평분.결과 4충항체균양성적UA환자전화위RA적양성솔위99%;임2충급2충이상항체양건적UA환자전화위RA적민감성83.0%,특이성65.9%;RF/항CCP항체양성적UA환자전화위RA적민감성77.8%,특이성80.5%;항체균음성화임1、2、3충항체양성급4충항체전양성환자적다관절종창급다개소관절수루적비솔분별위48%、57%、59%、70%、70%화71%、71%、72%、76%、82%;항체음성적UA환자중주관절수루소점비례최대,위72%;다관절종창급다개소관절수루재UA전화위RA여무다관절종창급다개소관절수루적전화솔최대.결론 4충항체연합검측가제고RA조기진단적특이성,양성항체월다.UA월용역발전위RA;RF/항CCP항체양성적UA환자전화위RA적민감성화특이성균교고.다관절종창화다개소관절수루대평고RA병정유중대의의.
Objective To investigate the clinical predictive value of rheumatoid factor (RF), anti-keratin antibodies (AKA), anti-cyclic citrullinated peptide (anti-CCP) antibody and anti-perinuclear factor (APF) in the transition from undifferentiated arthritis (UA) to rheumatoid arthritis (RA), and to analyze the clinical relevant factors. Methods 271 patients with UA who were followed up for a year were enrolled into the investigation. RF was measured by the rate scatting immunity method. APF and AKA were detected by immuniofluorescence method(IFA). Anti-CCP was measured by ELISA. Erythrocyte sedimentation rate (ESR) was analyzed by Wilcoxon method. The duration of morning stiffness, the numbers of swelling and tender joints, tender joints involved and DAS28 score were recorded and analyzed. Results 99% patients who had four-antibody-positive finally convetted from UA to RA. The conversation rate for those who had two or more than two antibody-positive was 83.0% and 65.9% respectively. The sensitivity and specificity of RF and anti-CCP antibody-positive in those who converted from UA to RA was 77.8% and 80.5% respectively. The percentage of polyarticular swelling in antibody-negative, one-antibody-positive, two-antibody-positive, three-antibody- positive and four-antibody-positive was 48%, 57%, 59%, 70% and 70% respectively. Meanwhile, the percentage of multi-small-joint involvement was 71%, 71%, 72%, 76% and 83% respectively. The proportion of elbow involvement in antibody-negative patients was 72%, which was the highest among all joint area involvement. The conversion differences of the group with more than 3 swelling joints or more than 3 small joints involvement ranked the first and second in frequency. Conclusion The combined detection of these autoantibodies could increase the specificity of early diagnosis of RA. The more positive antibodies present, the more likely the concersion form UA to RA. The sensitivity and specificity of RF and anti-CCP-positive is high, so the latter is expected to become one of the diagnostic criteria. The polyarticular swelling and multi-small-joint involvement are valuable in predicting the transformation from UA to RA.