血清及关节液中抗CarP抗体检测对RA诊断意义

发布时间：2018-03-11 20:48

  本文选题：类风湿关节炎　切入点：关节液　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过检测类湿关节炎(RA)患者血清及关节液中抗氨甲酰化蛋白抗体(抗CarP抗体)表达水平,探讨其对RA的诊断价值及其与疾病活动的关系。方法:选取108例RA患者,均来自山西医科大学第一临床医学院风湿免疫科2015年3月-2016年3月门诊及住院患者,同时选取我院门诊健康体检者30名作为对照组,分为RA组和健康对照组,详细记录相关临床资料,清晨抽取空腹外周血。选取同期伴有膝关节腔积液的RA患者31例及骨关节炎(OA)患者8例,抽取关节腔积液,分为RA关节液组及OA关节液组,收集并记录相关临床资料;用酶联免疫吸附法分别检测外周血血清及关节液中抗CarP抗体表达水平,以对照组均数()+2标准差(SD)为阈值,分析其对RA的诊断价值及与病情活动指标的相关性。结果:(1)RA血清及关节液中抗CarP抗体表达水平与对照组比较:血清中:RA组、健康对照组抗CarP抗体平均滴度分别为(3.724±2.104)U/ml、(1.165±0.851)U/ml,RA患者血清中抗CarP抗体表达水平显著高于健康对照组,差异有统计学意义(P0.01);关节液中:RA关节液组抗CarP抗体滴度为(4.676±1.893)U/ml,OA组为(1.971±0.967)U/ml,两组差异有统计学意义(P0.01)。RA组血清中及关节液中抗CarP抗体表达水平均高于对照组(健康对照组及OA关节液组)。(2)抗CarP抗体在RA中诊断价值:RA组、健康对照组血清中抗CarP抗体阳性数分别为50例(50/108)、2例(2/30),抗CarP抗体对于RA诊断灵敏度(Se)、X特异度(Sp)、阳性预测值(+PV)、阴性预测值(-PV)、ROC曲线下面积分别为46.3%、93.3%、96.2%、32.6%、0.901;RA及OA关节液检测抗CarP抗体阳性例数分别为15例(15/31)、1例(1/8),对于诊断RA的Se、Sp、+PV、-PV、ROC曲线下面积分别为48.4%、87.5%、93.8%、30.4%、0.923。两者均表现为特异性高,而灵敏性差,且对于诊断RA差异无统计学意义(P0.05)。(3)经Kendall’s Tau-b相关性分析提示抗CarP抗体与抗CCP抗体没有相关性。(4)108例RA患者中,抗CarP抗体及抗CCP抗体阳性数分别为50例、95例;两抗体均为阳性的RA患者为47例,均为阴性的为10例;抗CCP抗体阴性且抗CarP抗体阳性的RA患者数为3例,阳性率为3/13(23.1%)。(5)采用Spearman相关分析抗CarP抗体与RA病情活动相关性:抗CarP抗体水平均与DAS28评分、血沉(ESR)、C反应蛋白(CRP)、关节肿胀数(SJC)及关节压痛数(TJC)无关(r=-0.099;r=-0.070;r=-0.009;r=-0.003;r=-0.071,P值均0.05)。结论:抗CarP抗体在RA患者血清及关节液中高表达,对RA诊断具有较高特异性,可出现在抗CCP抗体阴性的RA患者中,但与病情活动无关,有望成为诊断RA的有效工具,尤其是抗CCP抗体阴性的RA。
[Abstract]:Objective: to investigate the diagnostic value of anti-carbamylated protein antibody (CarP antibody) in serum and joint fluid of patients with rheumatoid arthritis (RA) and its relationship with disease activity. Methods: one hundred and eight patients with RA were included in this study. All of them were from the Department of Rheumatological Immunology, the first Clinical Medical College of Shanxi Medical University, from March 2015 to March 2016. 30 healthy persons were selected as the control group and divided into RA group and healthy control group. The clinical data were recorded in detail and fasting peripheral blood was extracted in the morning. 31 patients with RA and 8 patients with osteoarthritis and OAA were selected and divided into RA joint fluid group and OA joint fluid group. To collect and record the relevant clinical data, to detect the expression of anti CarP antibody in peripheral blood serum and articular fluid by enzyme linked immunosorbent assay (Elisa). Results the expression of anti CarP antibody in RA serum and synovial fluid was compared with that in control group. The average titer of anti CarP antibody in healthy control group was 3. 724 卤2. 104U / ml respectively 1.165 卤0. 851U / ml RA patients' serum anti CarP antibody expression level was significantly higher than that in healthy control group. The titer of anti CarP antibody was 4.676 卤1.893U / ml in the synovial fluid group and 1.971 卤0.967U / ml in the OA group. There was significant difference between the two groups in the expression of anti CarP antibody in the serum and joint fluid of the two groups (healthy control group and healthy control group) (P < 0.01). The expression of anti CarP antibody in the synovial fluid was significantly higher than that in the control group (P < 0.01), and that in the control group was significantly higher than that in the control group (P < 0.05). The diagnostic value of anti CarP antibody in RA was in the group of 10% RA. In the healthy control group, the positive number of anti CarP antibody in serum was 50 / 10 / 10 8 / 2 / 2 / 30, respectively. The sensitivity of anti CarP antibody to RA was determined by the specificity of CarP X and the area under the curve of positive predictive value (P / V) was 46. 36.332. 632. 901RA and OA joint fluid, respectively. The number of positive cases of CarP antibody was 15 / 31 / 1 / 1 / 8 respectively. For the diagnosis of RA, the area under the PV-PVN curve was 48.4% and 93.8%, respectively. Both showed high specificity. Kendall's Tau-b correlation analysis showed that there was no correlation between anti CarP antibody and anti CCP antibody. In 108 RA patients, the positive number of anti CarP antibody and anti CCP antibody were 50 / 95 cases respectively. There were 47 cases of RA with both positive antibodies and 10 cases of negative, and 3 cases of RA with negative anti CCP antibody and positive anti CarP antibody. Spearman correlation analysis was used to analyze the correlation between anti CarP antibody and RA disease activity. The level of anti CarP antibody was correlated with DAS28 score. ESR C reactive protein (CRP), joint swelling and joint tenderness (TJC) were not related to rhi-0.099, r-0.070, r-0.009, r-0.003, r-0.071kp value. Conclusion: Anti-ESR antibody is highly expressed in serum and articular fluid of RA patients, and has a high specificity for the diagnosis of RA. It can be found in RA patients with negative anti CCP antibody, and it may be found in RA patients with negative anti CCP antibody, and it may be found in RA patients with negative anti CCP antibody, and it may be found that the anti CarP antibody is highly expressed in serum and articular fluid of RA patients, and has a high specificity in the diagnosis of RA, and can be found in RA patients with negative anti CCP antibody. But it has nothing to do with disease activity and is expected to be an effective tool for the diagnosis of RA, especially RAA, which is negative for anti-CCP antibodies.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.22

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