中华风湿病学杂志
中華風濕病學雜誌
중화풍습병학잡지
CHINESE JOURNAL OF RHEUMATOLOGY
2013年
1期
5-9
,共5页
张颖健%赵金霞%孙琳%李常虹%李桂叶%刘湘源%栗占国
張穎健%趙金霞%孫琳%李常虹%李桂葉%劉湘源%慄佔國
장영건%조금하%손림%리상홍%리계협%류상원%률점국
关节炎,类风湿%免疫球蛋白G%免疫球蛋白A%免疫球蛋白M%抗环瓜氨酸肽抗体
關節炎,類風濕%免疫毬蛋白G%免疫毬蛋白A%免疫毬蛋白M%抗環瓜氨痠肽抗體
관절염,류풍습%면역구단백G%면역구단백A%면역구단백M%항배과안산태항체
Arthritis,rheumatoid%Immunoglobulin G%Immunoglobulin A%Immunoglobulin M%Anti-cyclic citrullinated peptide
目的 检测早期类风湿关节炎(RA)患者血清中IgG、IgA和IgM亚型抗环瓜氨酸肽(CCP)抗体水平,分析3种亚型抗体在早期RA中的临床意义.方法 纳入病程＜2年的RA患者87例,其他风湿病患者61例,健康对照49名.以酶联免疫吸附法(ELISA)检测血清中IgG、IgA和IgM亚型抗CCP抗体水平,并分析各抗体亚型与RA患者临床和实验室指标的关系.统计学方法采用x2检验、t检验及Pearson相关分析.结果 ①IgG亚型和IrA亚型抗CCP抗体对诊断早期RA的敏感性分别为75.9％和67.8％,均明显优于IgM亚型抗CCP抗体(14％)(P均＜0.01).IgG、IgA及IgM亚型抗CCP抗体对诊断RA的特异性分别为96.4％、91.8％和93.6％.②IgG和IgA亚型抗CCP抗体均与CRP(r=0.278,P=0.01；r=0.217,P=0.047)和RF(r=0.430,P=0.000；r=0.271,P=0.012)呈正相关；IgM亚型与病程(r=0.279,P=0.014)呈正相关.③IgG-IgA+组患者病程(3.3±2.3)个月明显短于IgA-IgG+(11/28) (9.5±8.4)个月组和IgG+IgA+(8.2±7.0)个月组(P均＜0.05).④在IgG亚型抗CCP抗体阴性的RA患者中,仍有19.0％的患者可以检测到IgA亚型抗CCP抗体.IgG亚型和IgA亚型抗CCP抗体联合检测均阳性对早期RA诊断的敏感性为63.2％,特异性为100％,二者任一阳性的敏感性为80.5％,特异性为85.2％.结论 IgG和IgA亚型抗CCP抗体对早期RA的诊断均具有较高的敏感性,并且与病情活动相关,IgA亚型对IgG型抗CCP抗体阴性的RA患者具有一定的补充诊断作用,且IgG亚型阴性而IgA亚型阳性RA患者病程更短,提示IgA亚型抗CCP抗体可能在RA的更早期阶段发挥作用.
目的 檢測早期類風濕關節炎(RA)患者血清中IgG、IgA和IgM亞型抗環瓜氨痠肽(CCP)抗體水平,分析3種亞型抗體在早期RA中的臨床意義.方法 納入病程＜2年的RA患者87例,其他風濕病患者61例,健康對照49名.以酶聯免疫吸附法(ELISA)檢測血清中IgG、IgA和IgM亞型抗CCP抗體水平,併分析各抗體亞型與RA患者臨床和實驗室指標的關繫.統計學方法採用x2檢驗、t檢驗及Pearson相關分析.結果 ①IgG亞型和IrA亞型抗CCP抗體對診斷早期RA的敏感性分彆為75.9％和67.8％,均明顯優于IgM亞型抗CCP抗體(14％)(P均＜0.01).IgG、IgA及IgM亞型抗CCP抗體對診斷RA的特異性分彆為96.4％、91.8％和93.6％.②IgG和IgA亞型抗CCP抗體均與CRP(r=0.278,P=0.01；r=0.217,P=0.047)和RF(r=0.430,P=0.000；r=0.271,P=0.012)呈正相關；IgM亞型與病程(r=0.279,P=0.014)呈正相關.③IgG-IgA+組患者病程(3.3±2.3)箇月明顯短于IgA-IgG+(11/28) (9.5±8.4)箇月組和IgG+IgA+(8.2±7.0)箇月組(P均＜0.05).④在IgG亞型抗CCP抗體陰性的RA患者中,仍有19.0％的患者可以檢測到IgA亞型抗CCP抗體.IgG亞型和IgA亞型抗CCP抗體聯閤檢測均暘性對早期RA診斷的敏感性為63.2％,特異性為100％,二者任一暘性的敏感性為80.5％,特異性為85.2％.結論 IgG和IgA亞型抗CCP抗體對早期RA的診斷均具有較高的敏感性,併且與病情活動相關,IgA亞型對IgG型抗CCP抗體陰性的RA患者具有一定的補充診斷作用,且IgG亞型陰性而IgA亞型暘性RA患者病程更短,提示IgA亞型抗CCP抗體可能在RA的更早期階段髮揮作用.
목적 검측조기류풍습관절염(RA)환자혈청중IgG、IgA화IgM아형항배과안산태(CCP)항체수평,분석3충아형항체재조기RA중적림상의의.방법 납입병정＜2년적RA환자87례,기타풍습병환자61례,건강대조49명.이매련면역흡부법(ELISA)검측혈청중IgG、IgA화IgM아형항CCP항체수평,병분석각항체아형여RA환자림상화실험실지표적관계.통계학방법채용x2검험、t검험급Pearson상관분석.결과 ①IgG아형화IrA아형항CCP항체대진단조기RA적민감성분별위75.9％화67.8％,균명현우우IgM아형항CCP항체(14％)(P균＜0.01).IgG、IgA급IgM아형항CCP항체대진단RA적특이성분별위96.4％、91.8％화93.6％.②IgG화IgA아형항CCP항체균여CRP(r=0.278,P=0.01；r=0.217,P=0.047)화RF(r=0.430,P=0.000；r=0.271,P=0.012)정정상관；IgM아형여병정(r=0.279,P=0.014)정정상관.③IgG-IgA+조환자병정(3.3±2.3)개월명현단우IgA-IgG+(11/28) (9.5±8.4)개월조화IgG+IgA+(8.2±7.0)개월조(P균＜0.05).④재IgG아형항CCP항체음성적RA환자중,잉유19.0％적환자가이검측도IgA아형항CCP항체.IgG아형화IgA아형항CCP항체연합검측균양성대조기RA진단적민감성위63.2％,특이성위100％,이자임일양성적민감성위80.5％,특이성위85.2％.결론 IgG화IgA아형항CCP항체대조기RA적진단균구유교고적민감성,병차여병정활동상관,IgA아형대IgG형항CCP항체음성적RA환자구유일정적보충진단작용,차IgG아형음성이IgA아형양성RA환자병정경단,제시IgA아형항CCP항체가능재RA적경조기계단발휘작용.
Objective To evaluate the prevalence and clinical values of anti-cyclic citrullinated peptide (anti-CCP) antibodies of IgG,IgA and IgM subtypes in individuals with early rheumatoid arthritis (RA).Methods IgG,IgA and IgM subtypes of anti-CCP antibodies were measured in the sera of 87 RA patients with disease duration shorter than 2 years,61 patients with other rheumatic diseases and 49 healthy subjects.We analyzed the diagnostic value of IgG,IgA and IgM subtypes of anti-CCP antibodies and their relationship with disease duration,DAS28,ESR,CRP,and rheumatoid factor (RF).Chi-square test,t test and Spearman's correlation analysis were used for statistical analysis.Results ① The diagnostic sensitivity of IgG,and IgA subtype for early RA was 75.9％ and 67.8％ respectively,which was higher than IgM subtype (14％,P＜0.01 each).The specificity of IgG,IgA and IgM subtype was 96.4％,91.8％ and 93.6％ respectively.② IgG and IgA subtypes were correlated with CRP (r=0.278,P=0.01； r=0.217,P=0.047) and RF (r=0.430,P=0.000； r=0.271,P=0.012),while IgM subtype was positively correlated with disease duration (r=0.279,P=0.014).③ Patients who had IgG-and IgA subtype had a shorter disease course (3.3±2.3) than those patients who had IgA-and IgG+ (9.5±8.4) and who had IgG+ and IgA+ (8.2±7.0) (P＜0.05).④ IgA subtype was positive in 19.0％ of the IgG negative patients.When combining IgG,and antibodies of IgA subtypes together,the sensitivity and specificity was 63.2％ and 100％,while the sensitivity and specificity was 80.5％ and 85.2％ when either one was positive.Conclusion Both the IgG,and IgA subtypes of anti-CCP antibodies have a good sensitivity for early RA.They are related to disease activity.Measuring IgA subtype of anti-CCP antibody in RA patients with negative IgG subtype may help to identify early RA.IgA subtype of anti-CCP antibody may play a role in very early RA.
