抗瓜氨酸肽抗体谱在幼年类风湿关节炎诊断中的意义

目的探讨抗环瓜氨酸肽抗体（抗CCP抗体）、类风湿因子（RF）、抗核周因子（APF）、抗角蛋白抗体（AKA）对幼年类风湿关节炎（JRA）诊断的意义，并与类风湿关节炎（RA）进行比较。方法分别采用酶联免疫吸附试验（ELISA）、胶乳凝集法、间接免疫荧光法检测54例JRA患者、31例非RA对照组、116例成人RA患者血清中的抗CCP抗体、RF、APF、AKA。结果54例JRA患者抗CCP抗体、RF、APF、AKA的敏感性分别为61．1％、57．4％、37．0％、18．5％，特异性分别为96．8％、93．6％、96．8％、100％。抗CCP抗体与RF在JRA的敏感性差异无统计学意义，但明显高于APF、AKA;4种抗体在JRA的特异性比较差异无统计学意义。RA患者中4种抗体敏感性分别为82．3％、78．3％、48．7％、25．4％，特异性分别为95．7％、7．3．7％、91．6％、94．0％。4种抗体在JRA诊断中的敏感性均明显低于RA组，RF在JRA患者中特异性明显高于RA患者，而其他3种抗体的特异性在两组患者比较差异无统计学意义。结论虽然抗CCP抗体谱在JRA诊断中的敏感性不及RA组，但对JRA的诊断仍具有较好的敏感性和特异性，可用于JRA的诊断。     

RF、AKA、APF、抗CCP抗体联合检测对老年类风湿关节炎的诊断价值

目的研究类风湿因子(RF)、抗环瓜氨酸(CCP)抗体、抗角蛋白抗体(AKA)、抗核周因子抗体(APF)对老年类风湿关节炎(RA)的诊断价值。方法 RA患者480例为RA组,非RA自身免疫病患者300例为非RA组,健康组300例,对受检者进行RF、抗CCP抗体、AKA、APF检测。结果 RA组分别与非RA组和健康组比较,4种检测标志物阳性检出率均有显著性差异(P0.05)。单项指标比较,RF有较高的灵敏度,但特异性明显低于其他3个指标(P0.05),AKA、APF虽有较高的特异度,但灵敏度低(P0.05),抗CCP抗体有较高的灵敏度和特异度。对RA组各指标联合检测,以上指标任意2个组合比3项(抗CCP抗体+RF+APF,抗CCP抗体+RF+AKA)、4项(抗CCP抗体+RF+APF+AKA)联合检测敏感度低(P0.05),而特异度均较高,但没有明显差异(P0.05)。4项联合检测灵敏度及特异度达到最高。结论单项指标比较,抗CCP抗体有较高的灵敏度和特异度。联合指标比较,以抗CCP抗体+RF+APF或抗CCP抗体+RF+AKA3项联合检测模式诊断RA具有较高的价值,便于临床医师早期确诊,减少漏诊误诊病例。     

自身精氨酸肽的瓜氨酸化与类风湿关节炎

类风湿关节炎（rheumatoid arthritis，RA）患者血液中存在许多针对大量自身抗原的自身抗体，其中被广泛了解的是类风湿因子（RF），但RA中RF阳性率仅约75％，而且RF也可出现在其他风湿性疾病和感染性疾病中．甚至一部分正常人中，对RA的诊断价值受到限制。四十余年研究发现抗核周因子（APF）、抗角蛋白抗体（AKA）、抗丝聚蛋白抗体（anti-fi-laggrin antibody，AFA）、抗Sa抗体、抗环瓜氨酸肽（cyclic citrullinated peptide，CCP）抗体是RA的特异性抗体，这些抗体几乎不出现在其他风湿性疾病、炎症疾病以及正常人中．特别是抗CCP抗体对RA诊断的敏感性达80％，特异性达90％～100％。这些抗体所针对的抗原肽均包含非标准氨基酸一瓜氨酸，瓜氨酸肽是由肽酰基精氨酸脱亚氨酶（PADI）对包含精氨酸的肽脱亚氨基而来．因此这些抗体统称抗瓜氨酸肽抗体（ACPA）。     

类风湿关节炎自身抗体的新认识

类风湿关节炎 (ｒｈｅｕｍａｔｏｉｄａｒｔｈｒｉｔｉｓ,ＲＡ)是一种致残性疾病 ,发病 2年即可出现不可逆的骨关节破坏。现行的美国风湿病学会 (ＡＣＲ)诊断标准主要依靠临床表现、Ｘ线以及类风湿因子 (ＲＦ)检测。符合此标准时病人常已出现骨关节破坏 ,加之ＲＦ缺乏特异性 ,不利于早期诊断、早期干预治疗 ,因此临床需要能用于ＲＡ早期诊断的实验室指标。自从196 4年证实抗核周因子 (ａｎｔｉｐｅｒｉｎｕｃｌｅａｒｆａｃｔｏｒ,ＡＰＦ) [1] 是ＲＡ的特异性抗体并可在疾病早期出现后 ,又陆续发现抗角蛋白抗体 (ＡＫＡ) [2 ] 、抗聚角蛋白…     

抗环瓜氨酸肽抗体检测在类风湿关节炎中的意义

目的 检测抗环瓜氨酸肽（CCP）抗体在类风湿关节炎（RA）中的阳性率,探讨抗CCP抗体检测在RA中的意义。方法 以根据已知cDNA序列人工合成的CCP为抗原建立ELISA方法检测294例RA,132例其他风湿性疾病,135例非风湿性疾病中的抗CCP抗体的分布。比较抗CCP抗体与抗核周因子（APF）、抗角蛋白抗体（AKA）、类风湿因子（RF）以及HLA－DR4的相关性。结果 294例RA病人中,抗CCP抗体的阳性率为46．6％,其他风湿性疾病的阳性率为5．3％,非风湿性疾病的阳性率为1．5％。抗CCP抗体对RA的敏感性和特异性分别为46．6％,96．6％。抗CCP抗体与APF、AKA以及HLA－DR4之间有相关性,与RF之间无相关性。结论 抗CCP抗体对RA具有良好的敏感性（46．6％）和特异性（96．6％）,能用于RA的诊断。抗CCP抗体与AFP、AKA有相关性,但不完全重叠。抗CCP抗体可视为RA新的血清学诊断指标。     

类风湿关节炎相关自身抗体检测的临床应用专家共识

类风湿关节炎（RA）是一种常见的慢性、全身性自身免疫病,早期诊断、达标治疗是控制病情和改善预后的关键。RA患者可在血清中检测出类风湿因子和抗瓜氨酸化肽/蛋白抗体等多种自身抗体,其对RA早期诊断、鉴别诊断、判断疾病的严重程度及预后评估等均有重要价值。RA相关自身抗体检测的标准化对其临床应用至关重要。中国医师协会风湿免疫科...     

抗突变型瓜氨酸化波形蛋白抗体检测在类风湿关节炎中的意义

目的 评价抗突变型瓜氨酸化波形蛋白（MCV）抗体在类风湿关节炎（RA）诊断中的价值。方法 检测136例RA患者，80例其他结缔组织病患者以及19名正常对照血清中抗MCV抗体的分布，比较抗MCV抗体与类风湿因子（RF）、抗环瓜氨酸肽（CCP）抗体和抗角蛋白抗体（AKA）的相关性，并分析上述抗体在RA诊断中的意义。结果 136例RA患者抗MCV抗体敏感性和特异性分别为95．6％和80．8％．与非RA对照组比较差异有统计学意义（P〈0．05）。抗MCV抗体与抗CCP抗体、AKA和RF的重叠阳性率分别为91．9％、52．8％和76．5％。经统计学分析，抗MCV抗体与抗CCP抗体、AKA和RF之间存在相关性。结论 抗MCV抗体对RA有较高的诊断价值，可视为RA新的血清学诊断指标．能提高RA的早期诊断率。     

血清抗角蛋白抗体抗环瓜氨酸肽抗体和类风湿因子在类风湿关节炎中的意义

目的 评价抗角蛋白抗体(AKA)、抗环瓜氨酸肽(CCP)抗体和类风湿因子(RF)在类风湿关节炎(RA)中的意义.方法 收集82例RA患者及56例非RA患者,测定其抗CCP抗体、AKA和RF水平,评价对RA诊断的敏感性、特异性,比较RA患者中抗CCP抗体、AKA阳性组和阴性组的压痛关节数、肿胀关节数、红细胞沉降率(ESR)、C反应蛋白(CRP)、疾病活动指数(DAS)、Ritchie's指数(RAI).结果 单独检测AKA、抗CCP抗体、RF及联合检测的曲线下面积都较高(P<0.05).抗CCP抗体、AKA的特异度分别为92.9%、91.1%,联合检测AKA、抗CCP抗体和RF有任何一种及以上阳性的灵敏度最高,为95.1%.抗CCP抗体阳性组与阴性组的关节肿胀数、关节压痛数、ESR、CRP、DAS、RAI差异有统计学意义(P<0.05);AKA阳性组与阴性组的关节肿胀数、ESR、DSA差异均有统计学意义(P<0.05).结论 联合检测抗CCP抗体、RF、AKA对诊断RA有意义,抗CCP抗体、AKA可能与RA的活动度相关.     

抗CCP抗体检测对类风湿关节炎的临床诊断价值

类风湿关节炎(RA)诊断目前采用美国风湿病学会1987年修订的RA诊断分类标准,其中唯一的实验室指标是类风湿因子(RF),但其特异度不高,不利于早期诊断。即使符合7条标准中的4条以上,也常常造成误诊〔1〕。因此,寻找特异性检测指标对RA进行早期诊断成为近年研究热点。国内外研究     

老年类风湿性关节炎患者自身抗体检测及其临床意义

目的：探讨抗角蛋白抗体(AKA)、抗核周因子(APF)、抗Sa抗体及类风湿因子(RF)对老年类风湿性关节炎(EORA)临床诊断和判断预后的意义。方法：检测51例EORA患者血清中AKA、APF、抗Sa抗体及RF，结合临床资料分析。结果：AKA、APF、抗Sa抗体和RF对EORA诊断敏感性和特异性分别为31．4％和98．0％、70．6％和90．7％、37．3％和95．4％、51．0％和84．1％。以任两种抗体同时阳性判断，敏感性66．7％，特异性98．0％。AKA阳性组IgM、ESR较阴性组高(P=0．002，P=0．048)。3种或3种以上抗体阳性组中，医生对病情评估较阴性组、1种及2种抗体阳性组明显重(P=0．004，P=O．025，P=0．016)，患者对疼痛评估较1种及2种抗体阳性组重(P=0．028，P=0．021)，Sharp评分高于阴性组(P=0．048)。25例RF阴性EORA中，AKA、APF和抗Sa抗体阳性率分别为16％、60％和40％。AKA与APF呈正相关。结论：4种抗体联合检测有助于EORA尤其是RF阴性EORA的诊断；AKA可能系病情活动及严重的指标；3种或3种以上抗体阳性者病情较重、预后不良。     

类风湿关节炎相关动脉粥样硬化研究进展

类风湿关节炎心血管事件发生率较正常人增高已日益受到重视 ,研究认为它可能是动脉粥样硬化新的危险因素 ,甚至可能像糖尿病一样 ,成为动脉粥样硬化新的等危症。     

Idiopathic Hypoparathyroidism Associated with Adult Rheumatoid Arthritis

A 48-year-old female patient with adult onset idiopathic hypoparathyroidism diagnosed at the age of 28 years developed a typical seropositive rheumatoid arthritis (RA) at 46 years of age after several years of evolution of a palindromic rheumatism. Only one case of an association between idiopathic hypoparathyroidism and RA has been described in the medical literature. Autoimmunity seems to play a pivotal role in the aetiopathogenesis of both diseases, and could explain the nature of this association; nevertheless, a chance association could not be excluded.     

Anticardiolipin Antibodies in Juvenile Rheumatoid Arthritis and Systemic Lupus Erythematosus

Background: Antiphospholipid antibody syndrome (APS) can either occur as a primary syndrome or associated with other autoimmune diseases such as systemic lupus erythematosus (SLE). Anticardiolipin antibody (aCL) of IgG and/or IgM isotype in blood, measured by a standardized ELISA is the most acceptable laboratory criteria. APS IgG isotype, particularly IgG2 subclass is more strongly associated with thrombosis. Objectives: This study was done to determine the prevalence of IgG aCL and its subclasses in relation to APS symptoms, in a group of juvenile rheumatoid arthritis (JRA) and juvenile systemic lupus erythematosus (SLE) patients.   Methods: In this prospective study, 28 JRA and 16 SLE patients, aged 3-18 years, were enrolled. IgG aCL was assayed by standard aCL ELISA. IgG subclasses were also assayed by ELISA on sera with medium to high titers of aCL. ACL assay was performed on at least two occasions for each patient, over 3-6 months period of follow up.   Results: 29% (8/28) of JRA patients and 44% (7/16) of SLE patients had aCL. Six of SLE patients displayed APS related manifestations: hemolytic anemia, thrombocytopenia, arterial occlusion, valvular heart disease, livedo reticularis and pulmonary hypertension, but none of them had persistant medium or high titer of aCL. The lack of association of high titer of aCL with APS related symptoms was observed in two patients. The IgG subclasses were primarily IgG1 and IgG3.   Conclusion: The prevalence of IgG aCL in this group of pediatric SLE and JRA is not uncommon but it’s relation to clinical manifestations is not clear. IgG1 and IgG3 subclasses were not associated with thrombosis, which is in agreement with previous studies.     

Titers of Antibodies to Rana in Rheumatoid Arthritis and Normal Sera

The disease specificity of antibodies to rheumatoid arthritis nuclear antigen (RANA) was examined by comparing anti-RANA titers in sera from 100 patients with rheumatoid arthritis (RA) with sera from 93 healthy controls. Anti-RANA antibodies were found in 86% of the RA sera and 56% of the controls. The higher titers in the RA sera were unrelated to clinical features or to measurements of circulating immune complexes or rheumatoid factors. To study the relationship of these antibodies to previous Epstein—Barr virus (EBV) infection, antibodies to the EB virus capsid antigen (VCA) were examined and found in 94% of the RA sera and 97% of the adult controls. Four of the six RA sera without anti-VCA antibodies had detectable anti-RANA antibodies, so that we might suggest anti-RANA can arise in the absence of EBV infection. From absorption experiments with non-EBV transformed extracts, we inferred that high anti-RANA titers could be due to reactions with non-Epstein—Barr virus related nuclear antigens. These data cast doubt on current speculation about a possible pathogenic role for Epstein—Barr virus in this disease.     

The Molecular Basis of Self-Association of Antibodies to IgG (Rheumatoid Factors) in Rheumatoid Arthritis

The serum and synovial fluid of many patients with rheumatoid arthritis contain immune complexes composed of immunoglobulin G (IgG). In this study such complexes from one patient are shown to be formed by self-association of IgG-antibodies to IgG (IgG-rheumatoid factors), so that each molecule serves as an antibody as well as an antigen. All F(ab')(2) and Fab' fragments derived from these complexes have antibody binding sites for normal IgG. Due to a high association constant in the formation of a cyclic complex by these antibodies, normal IgG is excluded as an antigen. These studies serve as a model for further elucidation of presence of similar immune complexes in the serum and synovial fluid of patients with rheumatoid arthritis.