北京大学学报(医学版)
北京大學學報(醫學版)
북경대학학보(의학판)
JOURNAL OF BEIJING MEDICAL UNIVERSITY(HEALTH SCIENCES)
2014年
3期
478-482
,共5页
刘媛%王永福%王凯丽%吕凤凤
劉媛%王永福%王凱麗%呂鳳鳳
류원%왕영복%왕개려%려봉봉
干燥综合征%环瓜氨酸肽%自身抗体%生物学标记%血清
榦燥綜閤徵%環瓜氨痠肽%自身抗體%生物學標記%血清
간조종합정%배과안산태%자신항체%생물학표기%혈청
Sj?gren ’ s syndrome%Cyclic citrullinated peptide%Autoantibodies%Biological markers%Serum
目的:探讨免疫球蛋白G(immunoglobulin G, IgG)型抗环瓜氨酸肽(cyclic citrullinated peptides, CCP)抗体在原发性干燥综合征(primary Sj?gren’s syndrome,PSS)患者中的检出率及其在PSS中的意义。方法:选取2006年3月至2009年12月在包头医学院第一附属医院确诊的PSS患者120例,用酶联免疫吸附试验( enzyme-linked immunosorbent assay , ELISA )定量测定患者血清中的 IgG 型抗 CCP 抗体,免疫印迹法检测抗干燥综合征 A (Sj?gren’s syndrome type A,SSA)抗体和抗干燥综合征B(Sj?gren’s syndrome type B,SSB)抗体,魏氏法检测红细胞沉降率(erythrocyte sedimentation rate, ESR),免疫比浊法检测C反应蛋白(C reactive protein, CRP)、免疫球蛋白A ( immunoglobulin A , IgA)、IgM、IgG和IgM型类风湿因子( rheumatoid factor , RF)的水平,同时观察患者临床症状和重要脏器受累情况;对上述患者定期随访3年,观察其进展为类风湿关节炎(rheumatoid arthritis, RA)的情况。结果:(1)抗CCP抗体在PSS患者中的检出率为19.17%;(2)随访3年,抗CCP抗体阳性患者比阴性患者更容易进展为RA (χ2=5.015,P=0.022);(3)抗CCP 抗体阳性患者比阴性患者更容易出现关节受累(χ2=8.058,P<0.05),肿胀关节更多(U=152.00,P<0.05),晨僵持续时间更长(U=100.00,P<0.05),但两组患者重要脏器受累的比例相当(χ2分别为0.208、0.099、0.000、0.122,P>0.05);(4)抗CCP抗体阳性患者与阴性患者比较,抗SSA、SSB抗体的阳性率无明显差别(χ2分别为0.008、0.560,P>0.05);(5)多重线性回归显示,PSS患者抗CCP抗体的水平与IgM型RF水平呈正相关(B=0.61,95%CI=0.36~0.86, P<0.05),而与ESR、CRP、IgA、IgM及IgG等水平无明显的相关性(P>0.05);(6)抗CCP抗体阳性患者与阴性患者比较,ESR、CRP、IgA、IgM及IgG水平的差异无统计学意义(P>0.05),但抗CCP抗体阳性组IgM 型RF水平明显高于阴性组(U=623.50, P<0.05)。结论: IgG型抗CCP抗体在PSS中的阳性率为19.17%,与PSS患者关节受累相关,且抗CCP抗体阳性的患者更容易进展为RA。
目的:探討免疫毬蛋白G(immunoglobulin G, IgG)型抗環瓜氨痠肽(cyclic citrullinated peptides, CCP)抗體在原髮性榦燥綜閤徵(primary Sj?gren’s syndrome,PSS)患者中的檢齣率及其在PSS中的意義。方法:選取2006年3月至2009年12月在包頭醫學院第一附屬醫院確診的PSS患者120例,用酶聯免疫吸附試驗( enzyme-linked immunosorbent assay , ELISA )定量測定患者血清中的 IgG 型抗 CCP 抗體,免疫印跡法檢測抗榦燥綜閤徵 A (Sj?gren’s syndrome type A,SSA)抗體和抗榦燥綜閤徵B(Sj?gren’s syndrome type B,SSB)抗體,魏氏法檢測紅細胞沉降率(erythrocyte sedimentation rate, ESR),免疫比濁法檢測C反應蛋白(C reactive protein, CRP)、免疫毬蛋白A ( immunoglobulin A , IgA)、IgM、IgG和IgM型類風濕因子( rheumatoid factor , RF)的水平,同時觀察患者臨床癥狀和重要髒器受纍情況;對上述患者定期隨訪3年,觀察其進展為類風濕關節炎(rheumatoid arthritis, RA)的情況。結果:(1)抗CCP抗體在PSS患者中的檢齣率為19.17%;(2)隨訪3年,抗CCP抗體暘性患者比陰性患者更容易進展為RA (χ2=5.015,P=0.022);(3)抗CCP 抗體暘性患者比陰性患者更容易齣現關節受纍(χ2=8.058,P<0.05),腫脹關節更多(U=152.00,P<0.05),晨僵持續時間更長(U=100.00,P<0.05),但兩組患者重要髒器受纍的比例相噹(χ2分彆為0.208、0.099、0.000、0.122,P>0.05);(4)抗CCP抗體暘性患者與陰性患者比較,抗SSA、SSB抗體的暘性率無明顯差彆(χ2分彆為0.008、0.560,P>0.05);(5)多重線性迴歸顯示,PSS患者抗CCP抗體的水平與IgM型RF水平呈正相關(B=0.61,95%CI=0.36~0.86, P<0.05),而與ESR、CRP、IgA、IgM及IgG等水平無明顯的相關性(P>0.05);(6)抗CCP抗體暘性患者與陰性患者比較,ESR、CRP、IgA、IgM及IgG水平的差異無統計學意義(P>0.05),但抗CCP抗體暘性組IgM 型RF水平明顯高于陰性組(U=623.50, P<0.05)。結論: IgG型抗CCP抗體在PSS中的暘性率為19.17%,與PSS患者關節受纍相關,且抗CCP抗體暘性的患者更容易進展為RA。
목적:탐토면역구단백G(immunoglobulin G, IgG)형항배과안산태(cyclic citrullinated peptides, CCP)항체재원발성간조종합정(primary Sj?gren’s syndrome,PSS)환자중적검출솔급기재PSS중적의의。방법:선취2006년3월지2009년12월재포두의학원제일부속의원학진적PSS환자120례,용매련면역흡부시험( enzyme-linked immunosorbent assay , ELISA )정량측정환자혈청중적 IgG 형항 CCP 항체,면역인적법검측항간조종합정 A (Sj?gren’s syndrome type A,SSA)항체화항간조종합정B(Sj?gren’s syndrome type B,SSB)항체,위씨법검측홍세포침강솔(erythrocyte sedimentation rate, ESR),면역비탁법검측C반응단백(C reactive protein, CRP)、면역구단백A ( immunoglobulin A , IgA)、IgM、IgG화IgM형류풍습인자( rheumatoid factor , RF)적수평,동시관찰환자림상증상화중요장기수루정황;대상술환자정기수방3년,관찰기진전위류풍습관절염(rheumatoid arthritis, RA)적정황。결과:(1)항CCP항체재PSS환자중적검출솔위19.17%;(2)수방3년,항CCP항체양성환자비음성환자경용역진전위RA (χ2=5.015,P=0.022);(3)항CCP 항체양성환자비음성환자경용역출현관절수루(χ2=8.058,P<0.05),종창관절경다(U=152.00,P<0.05),신강지속시간경장(U=100.00,P<0.05),단량조환자중요장기수루적비례상당(χ2분별위0.208、0.099、0.000、0.122,P>0.05);(4)항CCP항체양성환자여음성환자비교,항SSA、SSB항체적양성솔무명현차별(χ2분별위0.008、0.560,P>0.05);(5)다중선성회귀현시,PSS환자항CCP항체적수평여IgM형RF수평정정상관(B=0.61,95%CI=0.36~0.86, P<0.05),이여ESR、CRP、IgA、IgM급IgG등수평무명현적상관성(P>0.05);(6)항CCP항체양성환자여음성환자비교,ESR、CRP、IgA、IgM급IgG수평적차이무통계학의의(P>0.05),단항CCP항체양성조IgM 형RF수평명현고우음성조(U=623.50, P<0.05)。결론: IgG형항CCP항체재PSS중적양성솔위19.17%,여PSS환자관절수루상관,차항CCP항체양성적환자경용역진전위RA。
Objective:To investigate the prevalence and significance of IgG-anti-cyclic citrullinated pep-tides (CCP) antibody in PSS patients .Methods:A total of 120 patients diagnosed with PSS were investi-gated in the first affiliated hospital of Baotou Medical College from March 2006 to December 2009.IgG-anti-CCP antibody was assayed by enzyme-linked immunosorbent assay (ELISA), also anti-Sj?gren’s syn-drome type A ( SSA) and Sj?gren’ s syndrome type B ( SSB) antibody were assayed by immunoblotting . Erythrocyte sedimentation rate ( ESR ) was assayed by westergren in serum , and C reactive protein (CRP), IgA, IgM, IgG and IgM-RF were detected by immune turbidimetric .At the same time, clinical symptoms and involvement of important organs were observed .Following up the patients above 3 years, the primary Sj?gren’ s syndrome ( PSS) patients who had progressed to rheumatoid arthritis ( RA) were evaluated .Results:The positive rate of anti-CCP antibody in the PSS patients was 19 .17%; After 3 years, more patients who were positive for anti-CCP antibody had progressed to RA (χ2 =5.015,P=0.022) than the patients in negative group;The patients in anti-CCP antibody positive group were more prone to joint involvement (χ2 =8.058,P<0.05), more swollen joints (U=152.00,P<0.05) and longer morning stiffness (U=100.00,P<0.05) than the patients with negative anti-CCP antibody, but the involvement of vital organs in the two groups had no significant difference (χ2 =0.208,0.099,0.000 and 0.122,P>0.05); The positive rate of anti-SSA and SSB antibody in anti-CCP antibody positive group and negative group had no significant difference (χ2 =0.008 and 0.56,P>0.05);Multiple linear regression showed that the level of anti-CCP antibody was positively correlated with IgM-RF levels in the PSS patients (B=0.61, 95%CI =0.36 -0.86, P<0.05), but had no significant correlation with ESR, CRP, IgA, IgM and IgG levels (P>0.05).There were no significant differences in the level of ESR, CRP, IgA, IgM and IgG between anti-CCP antibody positive group and negative group ( P >0.05), but the level of IgM-RF in anti-CCP antibody positive group was significantly higher than that in the negative group (U=623.50, P<0.05).Conclusion:Positive rate of IgG-anti-CCP antibody in PSS is 19 .17%, also it is associated with joint involvement and more prone to progressing to RA .