关节液中抗环瓜氨酸肽抗体在类风湿关节炎诊断和评估中的意义

目的:分析关节液中抗环瓜氨酸肽(CCP)抗体对类风湿关节炎(RA)的诊断和评估意义。方法:用ELISA法检测37例RA患者血清和关节液中的抗CCP抗体和13例对照组关节炎患者关节液中的抗CCP抗体,并测定类风湿因子(RF),记录RA患者的一些临床参数。对检测结果及临床参数进行统计分析。结果:关节液中抗CCP抗体对RA诊断的敏感度为72.9%,特异度为92.3%。RA组和对照关节炎组患者的关节液中抗CCP抗体的差异有显著性。RA组血清与关节液中抗CCP抗体的浓度高度相关(P<0.001),且关节液中抗CCP抗体与关节液中RF浓度有较高相关性(P<0.01)。RA组关节液中抗CCP抗体与病程相关,病程越长,抗CCP抗体滴度越高;而与肿胀关节数、压痛关节数、疾病活动评分(DAS28)、血清RF、红细胞沉降率(ESR)、C反应蛋白(CRP)和Steinbrocker放射线分级不相关。结论:关节液中抗CCP抗体对RA的诊断有高度特异性和较好敏感性,对其他关节炎有显著性差异,独立于一些临床参数,同时又与血清中抗CCP抗体及关节液中的RF相关。

Significance of synovial fluid anti-cyclic citrullinated peptide antibody in the diagnosis of rheumatoid arthritis

Objective To assess the significance of synovial fluid (SF) anti-cyclic citrullinated peptide antibody(CCP) in the diagnosis of rheumatoid arthritis (RA). Methods Anti-CCP was detected by ELISA in 37 serum and synovial fluid samples of RA patients and 13 synovial fluid samples of controls. Rheumatoid factor (RF) was also assayed. Some clinical parameters were recorded. The correlation of anti-CCP and those parameters was analyzed. Results The sensitivity and the specificity of SF anti-CCP were 72.9% and 92.3% respectively. There was significant difference in SF anti-CCP between RA patients and controls. SF anti-CCP had high correlation with serum anti-CCP (P<0.001) and with RF in SF (P<0.01). SF anti-CCP had correlation with duration of disease, but had no correlation with swollen joint count, tender joint count, DAS 28, serum RF, ESR, CRP, or Steinbrocker radiographic stage. Conclusions SF anti-CCP has satisfactory sensitivity and specificity in diagnosis of RA, independent from some clinical parameters, and has correlation with serum anti-CCP and RF in SF.