临床检验医学网-幸福检验

【摘要】  目的： 研究类风湿关节炎(rheumatoid arthritis, RA)患者血清抗环瓜氨酸肽(cyclic citrullinated peptide， CCP)抗体、类风湿因子(rheumatoid factor，RF)和白介素17(interleukin17，IL17)水平变化及临床应用价值。方法： 收集80例RA患者血清,以80例健康体检者血清作对照。采用双抗体夹心酶联免疫吸附法测定血清抗CCP抗体，IL17含量，特种蛋白仪检测RF含量，并进行统计分析。结果： RA患者活动期上述指标的含量均显著高于稳定期和健康对照组(P<0. 01)。RA患者组三项指标的阳性率明显高于正常对照组(P<0. 01)。RF诊断RA的敏感性高于抗CCP抗体及IL17，而抗CCP抗体对RA的特异性显著高于RF及IL17。两两联合检测及三者联合检测敏感性较单独检测都有所减低，而特异性增高明显，三者联合检测，特异性达到100%。结论： 动态监测抗CCP抗体、RF和IL17有助于观察RA病情变化，提高RA诊断率。

【关键词】  类风湿关节炎; 抗环瓜氨酸肽抗体; 类风湿因子; 白细胞介素17

作者：张 慧1，毛朝明1， 蒋 茜1， 仝 佳2， 王胜军2， 邵启祥2, 许化溪2， 焦志军1    作者单位：(1.江苏大学附属医院检验科， 江苏 镇江212001; 2.江苏大学基础医学与医学技术学院免疫学系， 江苏 镇江 212013)

　Clinical value of serum antiCCP antibody, RF and IL17 levels

　　in patients with rheumatoid arthritis

　　ZHANG Hui1， MAO Chaoming1, JIANG Qian1, TONG Jia2, WANG Shengjun2,

　　SHAO Qixiang2, XU Huaxi2, JIAO Zhijun1

　　(1.Department of Clinical Laboratory,the Affiliated Hospital of Jiansu University, Zhenjiang Jiangsu 212001; 2.Department of Immunology, School of Medical Science and Laboratory Medicine, Jiangsu University, Zhenjiang Jiangsu 212013, China)

　　[Abstract] Objective: To explore the clinical significance and the clinical value of changes of serum antiCCP antibody, rheumatoid factor(RF) and IL17 levels in patients with rheumatoid arthritis(RA). Methods： Serum antiCCP antibody and IL17 was detected in 80 case of RA and 80 case of healthy physical examines by enzyme linked immunosorbent assay(ELISA), Beckman automated protein analysis system was used to detect serum RF. Following, some statistical analysis for these data were done. Results： AntiCCP antibody, RF and IL17 levels in the acute phase of RA group were significantly higher than those in the stable phase of RA group and the healthy physical examines group (P<0. 01). Three detection items positive rate were apparently higher in RA group than in the healthy physical examines group (P<0. 01). Comparative analysis showed that RF sensitivity was higher than antiCCP antibody and IL17. But the antiCCP antibodies had higher specificity than RF and IL17. Sensitivity can be decreased when combining two or three detection items, but specificity can be event increased to 100% when combining three detection items. Conclusions： Not only monitoring the serum levels of antiCCP antibody, RF or IL17 was helpful for observation the development of rheumatoid arthritis，but also can improve diagnosis.

　　[Key words] rheumatoid arthritis; anticyclic citrullinated peptide antibody; rheumatoid factor; interleukin17 类风湿关节炎(rheumatoid arthritis, RA) 是常见的以关节滑膜慢性炎症病变为主要表现的自身免疫性疾病,不可逆的骨关节破坏,造成患者运动功能的丧失和生活质量的下降[1]。早期诊断，及时、有效的治疗可控制病情发展,阻止关节破坏,提高患者的生活质量。一些实验检测指标已应用于该病的临床诊断。类风湿因子(rheumatoid factor，RF)的敏感性高于抗环瓜氨酸肽(cyclic citrullinated peptide，CCP)抗体，而抗CCP抗体的特异性明显高于RF,二者具有良好的互补性，联合抗CCP抗体、RF检查有助于RA早期诊断 [2-3]。 最近发现白介素17(interleukin17，IL17)作为一种前炎症细胞因子与RA的病情密切相关，检测RA患者血清中的IL17是否也有助于观察其病情变化呢?这方面还鲜见报道。本研究对此作一探讨。