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目的:探讨抗环瓜氨酸肽(CCP)抗体对老年起病类风湿关节炎(EORA)诊断和预后评估的临床应用价值。方法:收集2010年3月至2011年3月在上海市第一人民医院分院风湿科门诊及住院治疗的EORA患者98例,骨性关节炎(OA)患者30例,风湿性多肌痛(PMA)患者10例,其他结缔组织病30例,正常老年健康对照48例,应用酶联免疫吸附法检测所有患者血清抗CCP抗体水平,并检测其IgM型类风湿因子(IgM-RF)。计算抗CCP抗体、IgM-RF及联合检测两者诊断EORA的特异度、敏感度、阳性预测值、阴性预测值。同时记录EORA患者的临床资料,分析抗CCP抗体阴性和阳性患者中年龄、性别、疾病活动指数28(DAS28)、ESR、CRP、骨损害的变化,对其预后进行预测。结果:EORA患者抗CCP抗体和IgM-RF的阳性率均明显高于其他结缔组织病患者和健康对照人群,差异均有统计学意义(P<0.05)。抗CCP抗体对EORA诊断的敏感性略低于IgM-RF,但特异性明显提高,差异均有统计学意义(P<0.05)。抗CCP抗体及IgM-RF对EORA诊断的敏感性和特异性分别为:61.2%、75.5%和97.1%、62.9%,两者联合检测的敏感性及特异性为:49%和98.5%。差异均有统计学意义(P<0.05)。抗CCP抗体阳性患者和阴性患者比较,年龄、性别、病程、ESR、CRP水平的差异均无统计学意义(P>0.05),但抗CCP抗体水平与DAS28评分呈正相关(P<0.05),与关节x线分期无明显相关性(P>0.05)。但抗CCP抗体阳性患者,更易出现骨损害,预后较差。结论:抗CCP抗体对诊断EORA具有较高的临床价值,且可以作为辅助预测和评价预后的指标。
Objective: To investigate the clinical value of anti-cyclic citrullinated peptide (CCP) antibody in diagnosis and prognosis of senile onset rheumatoid arthritis (EORA). Methods: A total of 98 EORA patients with rheumatoid disease outpatient department and hospitalized in Shanghai First People ’s Hospital Branch from March 2010 to March 2011 were collected. 30 patients with osteoarthritis (OA), 30 patients with rheumatic polymyalgia (PMA) ), 10 cases of other connective tissue diseases, 30 cases of normal connective tissue disease and 48 cases of normal elderly controls. Serum anti-CCP antibody levels of all the patients were detected by enzyme-linked immunosorbent assay. IgM-RF was detected. The specificity, sensitivity, positive predictive value, and negative predictive value of EORA for both anti-CCP, IgM-RF and combined tests were calculated. The clinical data of patients with EORA were also recorded. The age, sex, disease activity index 28 (DAS28), ESR, CRP and bone damage in anti-CCP antibody negative and positive patients were analyzed and their prognosis was predicted. Results: The positive rates of anti-CCP antibody and IgM-RF in EORA patients were significantly higher than those in other connective tissue disease patients and healthy controls (P <0.05). The sensitivity of anti-CCP antibody to EORA diagnosis was slightly lower than that of IgM-RF, but the specificity was significantly higher (P <0.05). The sensitivity and specificity of anti-CCP antibody and IgM-RF in diagnosis of EORA were 61.2%, 75.5% and 97.1%, 62.9% respectively. The sensitivity and specificity of the combined detection of anti-CCP and IgM-RF were 49% and 98.5% respectively. The differences were statistically significant (P <0.05). There was no significant difference in age, sex, course of disease, ESR and CRP between anti-CCP antibody positive patients and negative patients (P> 0.05), but there was a positive correlation between anti-CCP antibody and DAS28 score (P <0.05) Joint x-ray no significant correlation (P> 0.05). However, anti-CCP antibody-positive patients, more prone to bone damage, the prognosis is poor. Conclusion: Anti-CCP antibody has high clinical value in the diagnosis of EORA, and can be used as an index to predict and evaluate the prognosis.