CAJ | 학술논문

目的：探讨抗环瓜氨酸肽抗体（ CCP）和类风湿因子（ RF）联合检测对类风湿关节炎（ RA）的诊断价值，并分析抗CCP抗体浓度与RA的预后判断、药物反应和骨质破坏的临床相关性。方法：采用酶联免疫吸附法（ ELISA）和动态免疫散射比浊法分别检测480例RA患者和非RA患者血清中抗CCP抗体和RF。结果：抗CCP抗体对RA的敏感性和特异性分别为：83.0％、96.7％；RF对RA的敏感性和特异性分别为：76.0％、70.0％；二者联合检测，以抗CCP抗体阳性或RF阳性作为联合检测的阳性判定，以抗CCP抗体阴性且RF阴性作为联合检测的阴性判定，对RA的敏感性为87.0％，高于单独检测的敏感性；对RA的特异性为98.3％，高于单独检测的特异性。抗CCP抗体浓度在治疗前、治疗后3个月和治疗后6个月的RA患者间存在很大差异（P＜0.05）。 RA患者是否发生骨侵蚀，其抗CCP抗体浓度存在较大差异（P＜0.05）；而且关节损害越严重，其抗CCP抗体浓度越高（ P＜0.05）；随着治疗的进行，抗CCP抗体浓度的下降幅度在各组间也存在明显差异（ P＜0.05）。结论：联合检测抗CCP抗体和RF能够明显提高RA的诊断和鉴别诊断。抗CCP抗体浓度可随治疗有效而发生改变，动态监测可以作为考察药物疗效的观察指标。同时，抗CCP抗体水平能反映RA患者骨侵蚀的程度，且骨破坏严重者，治疗效果差。
목적：탐토항배과안산태항체（ CCP）화류풍습인자（ RF）연합검측대류풍습관절염（ RA）적진단개치，병분석항CCP항체농도여RA적예후판단、약물반응화골질파배적림상상관성。방법：채용매련면역흡부법（ ELISA）화동태면역산사비탁법분별검측480례RA환자화비RA환자혈청중항CCP항체화RF。결과：항CCP항체대RA적민감성화특이성분별위：83.0％、96.7％；RF대RA적민감성화특이성분별위：76.0％、70.0％；이자연합검측，이항CCP항체양성혹RF양성작위연합검측적양성판정，이항CCP항체음성차RF음성작위연합검측적음성판정，대RA적민감성위87.0％，고우단독검측적민감성；대RA적특이성위98.3％，고우단독검측적특이성。항CCP항체농도재치료전、치료후3개월화치료후6개월적RA환자간존재흔대차이（P＜0.05）。 RA환자시부발생골침식，기항CCP항체농도존재교대차이（P＜0.05）；이차관절손해월엄중，기항CCP항체농도월고（ P＜0.05）；수착치료적진행，항CCP항체농도적하강폭도재각조간야존재명현차이（ P＜0.05）。결론：연합검측항CCP항체화RF능구명현제고RA적진단화감별진단。항CCP항체농도가수치료유효이발생개변，동태감측가이작위고찰약물료효적관찰지표。동시，항CCP항체수평능반영RA환자골침식적정도，차골파배엄중자，치료효과차。
Objective:To investigate the diagnostic values of anti-cyclic citrullinated peptides antibody ( anti-CCP ) and rheumatoid factor( RF) in rheumatoid arthritis( RA) ,and analyse the clinical relevance of prognosis,drug reaction and bone destruction between anti-CCP and RA.Methods: Serum anti-CCP was detected by enzyme-linked immunosorbent assay ( ELISA ) , and RF was detected by immune rate nephelometry.Results:The sensitivity and specificity of anti-CCP in RA were 83.0%and 96.7%,while the sensitivity and specificity of RF in RA were 76.0%and 70.0%.When joint detect anti-CCP and RF,with anti-CCP or RF positive as a positive determination,with anti-CCP and RF negative as a negative judgment,the combined sensitivity was 87.0%,higher than that of detection alone.The combined specificity was 98.3%, higher than that of single detection.There were big different concentrations of anti-CCP among RA patients before treatment, three months after treatment and six months after treatment.There were significant differences between bone erosion and non-bone erosion in RA patients.And the more serious joint damage,the higher the concentrations of anti-CCP.As for treatment,anti-CCP concentrations declined.Conclusion:Combined detection of anti-CCP and RF can significantly improve the diagnosis and differential diagnosis of RA.The concentration of anti-CCP can change with effective treatment,then dynamic monitoring can be used as study drug efficacy.At the same time,the level of anti-CCP in patients with RA can reflect the degree of bone erosion,and serious bone destruction who was poor treatment effect.