本文選題：類風濕關節(jié)炎　切入點：關節(jié)液　出處：《山西醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:通過檢測類濕關節(jié)炎(RA)患者血清及關節(jié)液中抗氨甲酰化蛋白抗體(抗CarP抗體)表達水平,探討其對RA的診斷價值及其與疾病活動的關系。方法:選取108例RA患者,均來自山西醫(yī)科大學第一臨床醫(yī)學院風濕免疫科2015年3月-2016年3月門診及住院患者,同時選取我院門診健康體檢者30名作為對照組,分為RA組和健康對照組,詳細記錄相關臨床資料,清晨抽取空腹外周血。選取同期伴有膝關節(jié)腔積液的RA患者31例及骨關節(jié)炎(OA)患者8例,抽取關節(jié)腔積液,分為RA關節(jié)液組及OA關節(jié)液組,收集并記錄相關臨床資料;用酶聯免疫吸附法分別檢測外周血血清及關節(jié)液中抗CarP抗體表達水平,以對照組均數()+2標準差(SD)為閾值,分析其對RA的診斷價值及與病情活動指標的相關性。結果:(1)RA血清及關節(jié)液中抗CarP抗體表達水平與對照組比較:血清中:RA組、健康對照組抗CarP抗體平均滴度分別為(3.724±2.104)U/ml、(1.165±0.851)U/ml,RA患者血清中抗CarP抗體表達水平顯著高于健康對照組,差異有統計學意義(P0.01);關節(jié)液中:RA關節(jié)液組抗CarP抗體滴度為(4.676±1.893)U/ml,OA組為(1.971±0.967)U/ml,兩組差異有統計學意義(P0.01)。RA組血清中及關節(jié)液中抗CarP抗體表達水平均高于對照組(健康對照組及OA關節(jié)液組)。(2)抗CarP抗體在RA中診斷價值:RA組、健康對照組血清中抗CarP抗體陽性數分別為50例(50/108)、2例(2/30),抗CarP抗體對于RA診斷靈敏度(Se)、X特異度(Sp)、陽性預測值(+PV)、陰性預測值(-PV)、ROC曲線下面積分別為46.3%、93.3%、96.2%、32.6%、0.901;RA及OA關節(jié)液檢測抗CarP抗體陽性例數分別為15例(15/31)、1例(1/8),對于診斷RA的Se、Sp、+PV、-PV、ROC曲線下面積分別為48.4%、87.5%、93.8%、30.4%、0.923。兩者均表現為特異性高,而靈敏性差,且對于診斷RA差異無統計學意義(P0.05)。(3)經Kendall’s Tau-b相關性分析提示抗CarP抗體與抗CCP抗體沒有相關性。(4)108例RA患者中,抗CarP抗體及抗CCP抗體陽性數分別為50例、95例;兩抗體均為陽性的RA患者為47例,均為陰性的為10例;抗CCP抗體陰性且抗CarP抗體陽性的RA患者數為3例,陽性率為3/13(23.1%)。(5)采用Spearman相關分析抗CarP抗體與RA病情活動相關性:抗CarP抗體水平均與DAS28評分、血沉(ESR)、C反應蛋白(CRP)、關節(jié)腫脹數(SJC)及關節(jié)壓痛數(TJC)無關(r=-0.099;r=-0.070;r=-0.009;r=-0.003;r=-0.071,P值均0.05)。結論:抗CarP抗體在RA患者血清及關節(jié)液中高表達,對RA診斷具有較高特異性,可出現在抗CCP抗體陰性的RA患者中,但與病情活動無關,有望成為診斷RA的有效工具,尤其是抗CCP抗體陰性的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 鹵2. 104U / ml respectively 1.165 鹵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 鹵1.893U / ml in the synovial fluid group and 1.971 鹵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.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R593.22

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