抗氨基甲酰化蛋白抗体在诊断类风湿关节炎中的应用价值
Application value of anti-carbamylated protein antibody in the diagnosis of rheuma-toid arthritis
李正芳 1罗采南 1武丽君 1吴雪 1孟新艳 1陈晓梅 1石亚妹 1钟岩1
作者信息
- 1. 新疆维吾尔自治区人民医院风湿免疫科,新疆类风湿关节炎临床医学研究中心,乌鲁木齐 830001
- 折叠
摘要
目的:探讨抗氨基甲酰化蛋白(carbamylated protein,CarP)抗体在类风湿关节炎(rheumatoid arthritis,RA)中的表达水平及应用价值.方法:回顾2018年12月至2019年6月就诊于新疆维吾尔自治区人民医院风湿免疫科的RA患者、非RA患者以及体检中心健康对照人群的人口学资料、实验室检查结果及肌肉骨骼超声结果,采用间接酶联免疫吸附试验测定各研究对象血清中抗CarP抗体的浓度并进行统计学分析.结果:共纳入259例研究对象,其中RA组158例(包括血清阴性RA 45例),非RA组59例,健康对照组42例.RA组患者抗CarP抗体浓度[8.31(5.22,15.26)U/mL]高于非 RA 组[4.50(3.35,5.89)U/mL]及健康对照组[3.46(2.76,4.92)U/mL];非RA组抗CarP抗体浓度与健康对照组相比,差异无统计学意义(P=0.10).受试者工作特征(receiver operating characteristic,ROC)曲线分析抗CarP抗体诊断RA的灵敏度58.2％、特异度93.1％,抗CarP抗体、抗环瓜氨酸多肽(cyclic peptide containing citrulline,CCP)抗体及类风湿因子(rheumatoid factor,RF)三者联合检测时灵敏度 82.3％、特异度96.5％.抗CarP抗体在血清阴性RA患者中的阳性率为44.4％(20/45).单因素Logistic回归分析显示,年龄、C 反应蛋白(C-reactive protein,CRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、RF、葡萄糖-6-磷酸异构酶(glucose-6-phosphate isomerase,GPI)、抗CCP抗体、抗CarP抗体是RA发生的危险因素;多因素Logistic回归分析发现,抗CCP抗体、抗CarP抗体是RA发生的独立危险因素.Spearman相关性分析发现,抗CarP抗体与肿胀关节数、压痛关节数、ESR、28个关节的疾病活动度评分(disease activity score for 28 joints,DAS28)、临床疾病活动指数(clinical disease activity index,CDAI)、简化疾病活动指数(simplified disease activity index,SDAI)无明显相关性(P＞0.05).有骨侵蚀RA组患者(88例)抗CarP抗体浓度高于无骨侵蚀RA组(70例),差异有统计学意义(P＜0.05).结论:抗CarP抗体对RA的诊断有一定的价值.RF、抗CCP抗体、抗CarP抗体三者联合检测可提高其诊断价值,抗CarP抗体可能是血清阴性RA的有效辅助诊断工具.RA患者血清中高水平的抗CarP抗体浓度可能提示骨侵蚀风险增加,应早期干预治疗,但仍需进一步队列研究随访观察.
Abstract
Objective:To investigate the expression level and application value of anti-carbamylated protein(CarP)antibody in rheumatoid arthritis(RA).Methods:Demographic data and laboratory test results of RA patients,non-RA patients and healthy controls in the physical examination center were re-viewed from December 2018 to June 2019 in the Rheumatology and Immunology Department of the Peo-ple's Hospital of Xinjiang Uygur Autonomous Region.The serum concentrations of anti-CarP antibodies in all the subjects were measured by ELISA and statistically analyzed.Results:A total of 259 subjects were included in this study,including 158 in the RA group(45 serum-negative RA patients),59 in the non-RA group and 42 in the healthy control group.The concentration of anti-CarP antibody in RA group[8.31(5.22,15.26)U/mL]was higher than that in non-RA group[4.50(3.35,5.89)U/mL]and healthy control group[3.46(2.76,4.92)U/mL].The concentration of anti-CarP antibody in non-RA group was not significantly different from that in healthy control group(P=0.10).Receiver operating characteristic(ROC)curve analysis showed that the sensitivity of anti-CarP antibody in the diagnosis of RA was 58.2％,and the specificity was 93.1％.The sensitivity of the combined detection of anti-CarP antibody,anti-cyclic peptide containing citrulline(CCP)antibody and rheumatoid factor(RF)was 82.3％,and the specificity was 96.5％.The positive rate of anti-CarP antibody in serum-negative RA patients was 44.4％(20/45).Univariate Logisitic regression analysis showed that age,C-reactive pro-tein(CRP),erythrocyte sedimentation rate(ESR),RF,glucose-6-phosphate isomerase(GPI),anti-CCP antibody and anti-CarP antibody were risk factors for RA.Multivariate Logisitic regression analysis showed that anti-CCP antibody and anti-CarP antibody were independent risk factors for RA.Spearman correlation analysis showed that there was no significant correlation between anti-CarP antibody and swol-len joint count(SJC),tenderness joints count(TJC),ESR,disease activity score for 28 joints(DAS28),clinical disease activity index(CDAI),simplified disease activity index(SDAI).The concentration of anti-CarP antibody in RA with bone erosion(n=88)was higher than that in RA without bone erosion(n=70),and there was significant difference between the two groups(P＜0.05).Conclusion:Anti-CarP antibody is an effective serological marker for the diagnosis of RA.The combined detection of RF,anti-CCP antibody and anti-CarP antibody can improve its diagnostic value,and anti-CarP antibody may be an effective assistant diagnostic tool for serum negative RA.The high serum concentration of anti-CarP antibody in patients with RA may indicate an increased risk of bone erosion and should be treated early,but further cohort studies are needed for follow-up observation.
关键词
关节炎,类风湿/自身抗体/诊断/抗氨基甲酰化蛋白抗体Key words
Arthritis,rheumatoid/Autoantibodies/Diagnosis/Anti-carbamylated protein antibody引用本文复制引用
基金项目
新疆自治区重点研发项目(2022B03002-1)
出版年
2024
国家科技期刊平台
NSTL
万方数据