血清标志物在类风湿关节炎早期诊断中的临床价值
Clinical value of serum markers in early diagnosis of rheumatoid arthritis
  
DOI:10.3969/j.issn.1006-7108.2021.05.017
中文关键词:  血清标志物  类风湿关节炎  早期诊断
英文关键词:serum markers  rheumatoid arthritis  early diagnosis
基金项目:甘肃省青年基金项目(1806RJYM325)
作者单位
王龙龙1* 白敏1 张健2 1.庆阳市人民医院输血科甘肃 庆阳 745000 2.庆阳市人民医院骨科甘肃 庆阳 745000 
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中文摘要:
      目的 探讨血清中抗环瓜氨酸抗体(CCP)、抗突变型瓜氨酸波形蛋白抗体(MCV)、葡萄糖 6 磷酸异构酶抗原(GPI)、类风湿因子(RF)、基质金属蛋白酶3(MMP-3)、抗RA33、血清淀粉样蛋白A(SAA) 在类风湿关节炎(rheumatoid arthritis,RA)早期诊断中的意义。方法 选取早期RA患者160例、非RA风湿病患者100例、健康体检者100例,检测其血清中7种血清标志物的浓度,统计各指标阳性率,对所有数据进行统计学分析。结果 早期RA组血清中抗 CCP、抗MCV、GPI 抗原、RF、MMP-3、抗RA33、SAA平均水平显著高于非RA风湿病组和健康体检组水平(P<0.05)。3 组间各阳性率比较,差异具有统计学意义(P<0.05)。早期RA组抗MCV的敏感度最高(86.25%),其次为抗CCP(83.50%)、GPI抗原(83.50%)和RF(81.00%);结合特异度、Youden指数、阳性预测值和阴性预测值得出,单项抗CCP、抗MCV、GPI抗原、RF对早期RA的诊断能力较好,MMP-3中等,抗RA33和SAA较差。抗CCP、抗MCV、GPI抗原、RF 4项联合检测特异度最高(99.50%)。结论 抗CCP抗体、抗MCV抗体、GPI抗原、RF单项检测对早期RA的诊断能力较好,4项指标联合检测有助于早期RA的诊断和鉴别诊断。
英文摘要:
      Objective To explore the significance of serum anti-cyclic citrullinated peptide antibody (anti-CCP), anti-mutated citrullinated vimentin (MCV) antibody, glucose-6-phosphate isomerase (GPI) antigen, rheumatoid factor (RF), serum matrix metalloproteinases-3 (MMP-3), anti-RA33, and serum amyloid A (SAA) in the diagnosis of rheumatoid arthritis (RA). Methods One hundred and sixty patients with early RA, 100 patients with non-RA rheumatism, and 100 healthy persons were selected. The above mentioned 7 serum markers were detected. The positive rates of each index were counted and statistically analyzed. Results The average levels of serum anti-CCP, anti-MCV, GPI antigen, RF, MMP-3, anti-RA33, and SAA were markedly higher in early RA group than those in non-RA rheumatism group and healthy control group. There was statistical difference in the positive rates among the 3 groups (P<0.05). In early RA group, the sensitivity of anti-MCV was the highest (86.25%), followed by anti-CCP (83.50%), GPI antigen (83.50%), and RF (81.00%). Combined with specificity, Youden Index, positive predictive value, and negative predictive value, anti-CCP, anti-MCV, GPI antigen, and RF had better diagnostic value, MMP-3 had medium value, and anti-RA33 and SAA had poor values. Combination detection with anti-CCP, anti-MCV, GPI antigen, and RF had the highest specificity (99.50). Conclusion The single detection with anti-CCP, anti-MCV, GPI antigen, or RF has better diagnostic ability for early RA. The combination detection with the 4 markers is suitable for the early diagnosis and differential diagnosis of RA.
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