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目的:探讨Ⅰ型胶原吡啶交联终肽(ICTP)、抗环瓜氨酸肽(CCP)抗体及其它相关实验指标血清水平和联合检测在早期RA诊断与病情监测中的应用。方法:对入选的确诊早期RA116例、非RA组57例、正常对照组48例分别测定ICTP、抗CCP抗体、RF、CRP等,并记录相应的临床指标如性别、年龄、病程、晨僵时间、关节受累数等。结果:(1)抗CCP抗体、RF、CRP在RA各组血清水平均高于非RA组及对照组(P<0.05),抗CCP抗体在非RA组与正常对照组间比较,差别则无统计学意义(P>0.05);ICTP在中晚期显示较高含量,显著高于其它各组(P<0.05),早期RA组与非RA组中ICTP量值比较差别不明显(P>0.05),但与正常对照比较,均有差别(P<0.05)。(2)单项检测中对早期RA诊断的敏感性最高为RF,特异性指标最高为抗CCP抗体,抗CCP抗体等联合检测可提高对早期RA诊断的特异性,ICTP、抗CCP抗体、RF、CRP四项联合检测特异性达100%。(3)早期RA患者中多关节受累组和骨侵蚀组的血清ICTP、抗CCP抗体、RF、CRP水平均显著高于少关节受累组和无骨侵蚀组(P<0.05);血清ICTP、抗CCP抗体等与关节受累、骨侵蚀相关。(4)单纯使用非甾类抗炎药(NSAIDs)治疗早期RA患者,ICTP水平有上升趋势;患者采用抗风湿缓解药(DMARDs)治疗,ICTP半年内血清水平前后比较差别无统计学意义(P>0.05),抗CCP抗体在治疗后水平降低(P<0.05)。结论:联合检测抗CCP抗体、ICTP、RF等,可提高早期RA诊断的准确性,有重要临床意义;动态联合检测可有效监测RA病情进展及评价临床疗效;ICTP及抗CCP抗体能作为常规用于RA临床观察的实验室重点指标。
OBJECTIVE: To investigate the serum levels of ICTP, CCP antibody and other related experimental indicators of type Ⅰ collagen in the diagnosis and monitoring of early RA. Methods: ICTP, anti-CCP antibody, RF, CRP, etc. were determined in the early diagnosis of RA1 6 cases, non-RA group 57 cases and normal control group 48 cases, and the corresponding clinical indicators such as sex, age, duration of disease, morning stiffness time , The number of joint involvement. Results: (1) The serum levels of anti-CCP, RF and CRP in RA group were higher than those in non-RA group and control group (P <0.05), while the anti-CCP antibody in non-RA group and normal control group (P> 0.05). ICTP showed a higher content in the middle and late stages, which was significantly higher than other groups (P <0.05). There was no significant difference in the ICTP values between early RA group and non-RA group (P> 0.05) , But compared with the normal control, there was a difference (P <0.05). (2) The highest sensitivity for early diagnosis of RA was RF and the highest specificity was anti-CCP antibody. The combined detection of anti-CCP antibody could improve the specificity of diagnosis of early RA, ICTP, anti-CCP antibody, CRP four joint detection of specific 100%. (3) The serum levels of ICTP, anti-CCP, RF and CRP in patients with multi-joint involvement and bone erosion in RA group were significantly higher than those in less-affected joint group and non-bone erosion group (P <0.05) Antibodies such as CCP are associated with joint involvement and bone erosion. (4) The use of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of early RA patients, ICTP levels are on the rise; patients with anti-rheumatic drugs (DMARDs) treatment, ICTP within six months before and after serum levels were no significant difference > 0.05), anti-CCP antibody levels decreased after treatment (P <0.05). Conclusion: The combined detection of anti-CCP antibody, ICTP, RF and so on can improve the accuracy of early RA diagnosis and has important clinical significance. The dynamic joint detection can effectively monitor the progression of RA and evaluate the clinical curative effect. ICTP and anti-CCP antibody can be used as routine Key Laboratory Indicators for RA Clinical Observation.