4种血清标志物在类风湿关节炎的诊断、疾病活动度的判断及骨侵蚀的预测的应用价值

目的 研究葡萄糖6 磷酸异构酶( GPI)、类风湿因子( RF)、抗角蛋白抗体( AKA)、抗环瓜氨酸肽( CCP)抗体4种血清标志物在类风湿关节炎( RA)疾病的诊断、疾病活动度的判断及骨侵蚀的预测方面的应用价值. 方法 选取193例RA患者, 158 例非 RA 患者, 98 例健康体检者. 采用ELISA法定量检测GPI和抗CCP抗体浓度水平,免疫透射比浊法定量检测RF浓度水平,采用间接免疫荧光法定性检测AKA. 结果 血清GPI、RF、抗CCP抗体、AKA阳性率在RA组与非RA组及健康对照组比较差异均有统计学意义( P<0. 05);血清GPI、RF、抗CCP抗体浓度水平在RA组显著高于非RA组及健康对照组,差异有统计学意义( P<0. 05 ).血清GPI、RF浓度水平在RA活动组浓度显著高于非活动组,差异有统计学意义( P<0. 05 );血清抗CCP抗体浓度水平在RA活动组与非活动组比较差异无统计学意义. 血清GPI、RF浓度水平在RA骨侵蚀组与非骨侵蚀组比较差异无统计学意义;血清抗CCP抗体浓度水平在RA骨侵蚀组显著高于非骨侵蚀组,差异有统计学意义( P<0. 05 ). 血清AKA阳性率在RA活动组与非活动组比较,差异无统计学意义;在RA骨侵蚀组与非骨侵蚀组比较,差异有统计学意义( P<0. 05). 结论 血清 GPI、RF、抗 CCP 抗体、AKA 的水平对RA的诊断起到重要作用,血清GPI、RF浓度水平与RA患者疾病活动度有关,血清抗CCP抗体浓度水平可以预测RA患者骨侵蚀,RA患者血清AKA阳性可能与骨侵蚀有关.

Values of four serum markers in the diagnosis,the assessment of disease activity and the prediction of bone erosion of rheumatoid arthritis

Objective To systematically evaluate the values of four serum markers including glucose-6-phosphate isomerase ( GPI ) , rheumatoid factor ( RF ) , anti-keratin antibody ( AKA ) and anti-cyclic citrullinated peptide ( CCP) antibody in the diagnosis, the assessment of disease activity and the prediction of bone erosion of rheumatoid arthritis(RA). Methods The serum samples of 193 patients with RA,158 non-RA rheumatic patients and 98 healthy controls were collected. The expressions of GPI and anti-CCP were measured by ELISA methods. The level of RF was measured by the immune turbidimetric methods; AKA was measured by indirect immunofluorescence methods. Results The positive rates of these four antibodies in RA patients were significantly higher than in non-RA rheumatic patients and healthy controls group(P<0. 05),the combined detection of these four antibodies could obviously improve the sensitivity and the specificity in the diagnosis of RA. The mean levels of GPI ,RF and anti-CCP were significantly higher in RA patients than that of in non-RA rheumatic patients and healthy controls group ( P<0. 05 ) . There were significant differences between the active phase and the inactive phase in the GPI and RF levels(P<0. 05);with the value of the anti-CCP,there was no difference between the active phase and the inactive phase. The levels of GPI and RF in the bone erosion group and the non-bone erosion group had no significant difference;with the value of the anti-CCP,there was obvious difference between the bone erosion group and the non-bone erosion group(P<0. 05). The positive rate of AKA in the active phase and the inactive phase had no differ-ence;while,there was significant difference between the bone erosion group and the non-bone erosion group ( P<0. 05 ) . Conclusion The combined detection of these four antibodies has important clinical significance in the di-agnosis of RA. The serum concentrates of GPI and RF have significantly positive correlation with disease activity of RA. It is valuable to predict the bone erosion of RA, using detection of anti-CCP. The patients with positive AKA may exhibit more bone damage.