抗环瓜氨酸肽抗体与系统性红斑狼疮关节炎的相关性研究

目的 研究抗环瓜氨酸肽(CCP)抗体在系统性红斑狼疮(SLE)患者中的临床意义,探讨抗CCP抗体与SLE患者关节炎及骨侵蚀的关系.方法 采用酶联免疫吸附试验(ELISA)方法检测138例SLE患者血清中抗CCP抗体水平,并与SLE患者关节表现及其他临床指标进行相关性分析.结果 抗CCP抗体在SLE患者中的阳性率为13.8%(19/138).SLE患者关节炎的发生率为50.7%,关节炎组抗CCP抗体阳性率(20%)高于非关节炎组(7.4%)(P＜0.05).在SLE关节炎患者中,抗CCP抗体阳性者类风湿因子(RF)阳性率显著高于抗CCP抗体阴性者(71.4%与14.3%)(P＜0.01).而且,抗CCP抗体与RF之间显著相关(r=0.36,P=0.002).抗CCP抗体阳性的SLE患者关节炎的发生率明显高于抗CCP抗体阴性者(73.7%与47.1%,P＜0.05).138例SLE患者中有8例出现受累关节的影像学改变,与抗CCP抗体阴性患者相比,抗CCP抗体阳性患者表现出侵蚀性关节炎的比例显著为高(35.7%与5.4%,P＜0.01).在8例表现为侵蚀性关节炎的患者中有2例患者抗CCP抗体和RF均阴性,而抗RA33抗体阳性.此8例患者均满足美国风湿病学学会(ACR)1987年类风湿关节炎(RA)的分类标准.SLE相关其他临床指标分析显示,关节炎组.与非关节炎组、抗CCP抗体阳性组与阴性组之间差异均无统计学意义.结论 13.8%的SLE患者体内存在抗CCP抗体.抗CCP抗体的出现与SLE患者关节炎和骨侵蚀密切相关,并对判断SLE关节炎的预后具有重要的临床价值.

Clinical significance of anti-cyclic citrullinated peptides antibodies in systemic lupus erythematosus patients with arthritis

Objective To investigate the clinical significance of anti-cyclic citrullinated peptides antibodies (anti-CCP) in systemic lupus erythematosus (SLE) patients with arthritis.and to explore the association of anti-CCP with erosive arthritis in SLE patients.Methods Serum samples from 138 SLE patients were examined for anti-CCP with the second generation anti-CCP detection commericial kit.The association between anti-CCP antibodies and clinical features as well as laboratory parameters.especially arthritis,in these SLE patients were analyzed.Results The frequency of anti-CCP was 13.8% (19/138) in this group of SLE patients.Seventy of 138 SLE patients had experienced arthritis.of whom 14 were anti-CCP positive.Anti-CCP antibodies were more frequently detected in SLE patients with arthritis than those without arthritis (20% vs 7.4%,P＜0.05).A statistical correlation between anti-CCP and rheumatoid factor (RF) was found in SLE patients with arthritis (r=0.36,P=0.002).The frequency of arthritis was significantly higher in SLE patients with anti-CCP than without (73.7% vs 47.1%,P＜0.05).Eight out of 138 SLE patients showed ioint erosions on radiographs.When compared with anti-CCP negative patients,erosive arthritis occurred more often in anti-CCP positive patients (35.7% vs 5.4%.P＜0.001).Interestingly.two patients without anti-CCP and RF but with erosive arthritis were anti-RA33 antibodies positive.All 8 SLE patients with erosive arthritis in our study fulfilled 1987 ACR criteria for RA.With regard to other clinical and laboratory features.there were no differences between SLE patients with or without arthritis or between patients with positive and negative anti-CCP antibodies.Conclusions Anti-CCP antibodies have a prevalence of 13.8% in our group of SLE patients and its presence is closely associated with arthritis.Moreover,the presence of anti-CCP antibodies may be a good marker to predict the outcome of SLE arthropathy.