ICTP、MMP-3、抗CCP抗体和RF检测对早期RA患者的诊断应用

摘要

目的:探讨I型胶原吡啶交联终肽(ICTP)、基质金属酶-3 (MMP-3) 、抗环瓜氨酸肽抗体(抗CCP抗体)、类风湿因子(RF)检测对于早期类风湿关节炎(RA)患者疾病进程的预测价值.方法:2010年1月~2012年6月对我院风湿免疫科门诊及住院RA患者249例(RA组,其中早期RA112例)、非RA的其他免疫系统疾病患者41例(非RA对照组)及健康对照(正常对照组)60例,采用ELISA定量检测血清ICTP、MMP-3、抗CCP抗体,采用免疫比浊法测定血清RF.结果:① 抗CCP抗体、RF在RA各组血清水平均高于非RA及正常对照组(P0.05);MMP-3在中晚期具有较高含量,显著高于其它各组(P0.05),但与正常对照组比较,均有统计学意义(P0.05),但可同时作为RA早期诊断指标.③ICTP 、MMP-3、抗CCP抗体与RF表明,四种血清标志物联检对早期RA诊断灵敏度为43.8%,特异性99.0%,诊断早期RA的敏感性有所下降,但特异性有所提高.结论:联检四种血清标志物可降低RA的漏诊率.动态联检ICTP、抗CCP抗体、RF、MMP-3能更有效地及时监测RA的疾病进展,对指导临床诊治及干预有积极意义.%Objective To explore the end of the cross-linking of type Ⅰ collagen pyridine final peptide pyridine( ICTP) , matrix metalloenzymes -3 and ( MMP-3 ) , anti-cyclic citrullinated peptide ( CCP) antibodies, rheumatoid factor ( RF) detection for early rheumatoid arthritis ( RA) patients and the predictive value of the disease process. Methods From January 2010 to June 2012, 249 cases of rheumatism in outpatient department and hospitalized patients with RA (RA group, which 121 cases were early RA) and 41 cases of non-RA patients with other immune system diseases (non-RA control group) and 60 cases of healthy subjects (healthy control group) , using quantitative EOSA to measure serum ICTP, MMP-3, anti-CCP antibodies. Besides, serum RF with turbidimetric unmu-noassay. Results (1) Anti-CCP, RF serum levels in RA on average showed significantly higher than non-RA and the control group (P 0.05) ; MMP-3 has a higher content in the middle and late period, which manifested markedly higher than the other groups ( P 0.05) compared to early RA patients with long-term RA group compared with the normal control group, were different (P 0.05), but might be used as an indicator in early diagnosis of RA. (3) ICTP, MMP-3, anti-CCP and and RF four serum standards, combined detection of early RA diagnosis , the sensitivity 43. 896 and specificity 99.0% individually, decreased in the sensitivity for diagnosis of early RA, but the specificity increased. Conclusion Combined detection of four serum indicators, can reduce the rate of misdiagnosis of RA. Dynamic joint determination of ICTP, anti-CCP antibodies, RF and MMP-3 could be more effective and timely monitoring of disease progression in RA also guiding clinical treatment and intervention.