血D-二聚体、抗环瓜氨酸肽抗体、血黏度联合检测与类风湿性关节炎之间相关性探讨

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田军. 血D-二聚体、抗环瓜氨酸肽抗体、血黏度联合检测与类风湿性关节炎之间相关性探讨. 检验医学,2014, 29(7): 778-779[田军. Labratory Medicine, 2014, 29(7): 778-779] 复制到剪切板

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血D-二聚体、抗环瓜氨酸肽抗体、血黏度联合检测与类风湿性关节炎之间相关性探讨

田军

余姚市第二人民医院检验科,浙江余姚 315400

作者简介:田军,男,1977年生,学士,主管技师,主要从事临床检验工作。

摘要

类风湿关节炎(rheumatoid arthritis,RA)是一种常见的自身免疫性疾病,以关节滑膜炎和血管炎为主要表现、对关节软骨和骨质产生进行性、不可逆破坏^[1]。故RA早期诊断和监测对RA的治疗、控制病情、改善预后非常重要。传统的指标类风湿因子(rheumatoid factor,RF)敏感性为60%80%^[2],且特异性不高。本研究通过测定RA患者的D-二聚体、抗环瓜氨酸肽(cyclic citrullinated peptide,CCP)抗体、血黏度,探讨其在RA早期诊断中的作用及与RA疾病活动性评分(disease activity score-28, DAS28)的相关性,为评价凝血-纤溶系统异常在RA发展过程中的作用提供实验室依据。

关键词: 类风湿性关节炎; D-二聚体; 抗环瓜氨酸肽抗体; 血黏度; 相关性

中图分类号:R446.62 文献标志码:B 文章编号:1673-8640(2014)07-0778-02

田军

Abstract

Keyword:

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一、材料和方法

1.临床资料

RA患者84例,其中男36例,女性48例,年龄(53±13)岁。所有病例诊断均符合美国风湿病学会1987年修订的RA分类标准^{[ 3]}。对照组为同期体检健康者,共60例,性别及年龄分布一致,排除高血脂、糖尿病、血栓等凝血-纤溶异常病例。

2.方法

采集所有对象空腹静脉血。用免疫荧光法检测D-二聚体,试剂由梅里埃公司提供;用化学发光法检测抗CCP抗体,试剂由罗氏公司提供;用椎板法检测血黏度值,仪器及试剂由美医林公司提供。对RA患者进行DAS28评分。

3. 统计学方法

采用SPSS 17.0软件进行统计分析。数据以 ±s表示,计量资料比较用 t检检。相关性用双变量直线相关分析。 P<0.05为差异有统计学意义

二、结果

RA组D-二聚体、抗CCP抗体、全血黏度(高切)、全血黏度(低切)、血浆黏度值均明显高于对照组( P<0.05)。见表1:

表1 RA组与对照组D-二聚体、抗CCP抗体、血液黏度值比较(

±s)

将RA组按DAS28≥5.1和<3.2 分为高疾病活动组和低疾病活动组^{[ 4]}分别统计,结果显示两组间D-二聚体、抗CCP抗体差异有统计学意义( P<0.05)。见表2:

表2 高疾病活动组和低疾病活动组D-二聚体、抗CCP抗体、血液黏度值比较(

±s)

RA组D-二聚体、抗CCP抗体与临床疾病活动情况的相关性分析显示D-二聚体、抗CCP抗体浓度与DAS28评分呈明显正相关( r值分别为0.66、0.67, P均<0.05)。血黏度3项指标与DAS28评分的相关性不明显。

三、讨论

RA患者的炎症关节腔内纤维蛋白原及凝血酶原等血浆成分因炎症渗入而异常升高,在炎症因子的介导下激活凝血系统,导致凝血酶原活化、纤维蛋白的形成及纤维凝块沉积。沉积的纤维蛋白在肽酰基精氨酸脱亚氨酶的作用下发生瓜氨酸化,并与抗瓜氨酸酸化蛋白抗体结合导致纤维蛋白降解,进一步激活纤溶系统,使患者体内的凝血-纤溶系统异常激活、紊乱。炎症灶向外周循环系统持续释放D-二聚体、抗CCP抗体、炎症因子等产物,导致外周血中D-二聚体、抗CCP抗体、血黏度值的异常升高。血黏度值异常升高使血液呈高凝状态^{[ 5]} ,进一步加剧凝血-纤溶系统的紊乱。

为验证凝血-纤溶系统的异常激活和紊乱在RA发展过程中的作用,本研究比较了RA组和对照组的抗CCP抗体、D-二聚体、血黏度值。结果显示RA组抗 CCP抗体、D-二聚体、血黏度值明显高于对照组( P<0.05),进一步分析显示抗CCP抗体、D-二聚体在RA高活动组与低活动组之间也存在明显差异,抗CCP抗体、D-二聚体与DAS28评分呈明显正相关。以上结果均表明了上述指标联合监测在RA的早期诊断与治疗监测中有较好的敏感性与特异性。该结论与相关文献^{[ 6, 7]}中的评价相一致,3项指标的综合判断将有助于类风湿性节炎的早期诊断与病情监测、疗效评估。

The authors have declared that no competing interests exist.

参考文献

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[1]	Busso N, Hamilton JA. Extravascular coagulation and the plasminogen activator/plasmin system in rheumatoid arthritis[J]. Arthritis Rheum, 2002, 46(9): 2268-2279. [本文引用:1] [JCR: 7.477]
[2]	赵超, 王雪. 类风湿因子定量检测在类风湿关节炎诊治中的应用[J]. 实用医技杂志, 2005, 12(10): 1345. [本文引用:1]
[3]	Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis[J]. Arthritis Rheum, 1988, 31(3): 315-324. [本文引用:1] [JCR: 7.477]
[4]	Prevoo ML, van't Hof MA, Kuper HH, et al. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis[J]. Arthritis Rheum, 1995, 38(1): 44-48. [本文引用:1] [JCR: 7.477]
[5]	和虹, 褚榆林, 邵宗鸿. 类风湿性关节炎相关性血液学异常[J]. 中华血液学杂志, 2002, 21(10): 556. [本文引用:1]
[6]	蔡小慧, 吕星, 卿之驹. IgM-RF、IgG-RF、IgA-RF及抗CCP对类风湿性关节炎的诊断价值[J]. 检验医学, 2012, 27(12): 1066-1069. [本文引用:1]
[7]	牛瑞兵, 郭利平. 几种自身抗体辅助诊断类风湿性关节炎临床应用评价[J]. 检验医学, 2013, 28(7): 657-658. [本文引用:1]

2002

7.477

0.0

. 2002, 46(9):2268-2279

Extravascular coagulation and the plasminogen activator/plasmin system in rheumatoid arthritis

Nathalie Busso 1 andJohn A. Hamilton 2,*

1 Centre Hospitalier Universitaire Vaudois University Hospital, Lausanne, Switzerland 2 Arthritis and Inflammation Research Centre, University of Melbourne, The Royal Melbourne Hospital, Parkville, Victoria, Australia * Arthritis and Inflammation Research Centre, Department of Medicine, University of Melbourne, The Royal Melbourne Hospital, Parkville, Victoria 3050, Australia

> First page of article

2005

0.0

1988

7.477

0.0

. 1988, 31(3):315-324

The american rheumatism association 1987 revised criteria for the classification of rheumatoid arthritis

Frank C. Arnett MD 1,19,* ,Steven M. Edworthy MD 2,19 ,Daniel A. Bloch PhD 3,19 ,Dennis J. Mcshane MD 4,19 ,James F. Fries MD 5,19 ,Norman S. Cooper MD 6,19 ,Louis A. Healey MD 7,19 ,Stephen R. Kaplan MD 8,19 ,Matthew H. Liang MD MPH 9,19 ,Harvinder S. Luthra MD 10,19 ,Thomas A. Medsger Jr MD 11,19 ,Donald M. Mitchell MD 12,19 ,David H. Neustadt MD 13,19 ,Robert S. Pinals MD 14,19 ,Jane G. Schaller MD 15,19 ,John T. Sharp MD 16,19 ,Ronald L. Wilder MD PhD 17,19 andGene G. Hunder MD 18,19

1 Professor of Internal Medicine, The University of Texas Health Science Center at Houston 2 Fellow of Immunology, Stanford University School of Medicine, Stanford, CA 3 Senior Research Associate of Biostatistics in Immunology, Stanford University School of Medicine 4 Assistant Professor of Immunology, Stanford University School of Medicine 5 James F. Fries, MD: Associate Professor of Medicine, Stanford University School of Medicine 6 Professor of Pathology, New York University School of Medicine, New York, NY 7 Virginia Mason Clinic, Seattle, WA 8 Professor of Medicine, Brown University Program in Medicine, Providence, RI 9 Associate Professor of Medicine, Harvard Medical School, Boston, MA 10 Associate Professor of Medicine, Mayo Medical School and Clinic, Rochester, MN 11 Professor of Medicine, University of Pittsburgh, Pittsburgh, PA 12 Professor of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada 13 Clinical Professor of Medicine, University of Louisville School of Medicine, Louisville, KY 14 Professor of Medicine, UMDNJ-Robert Wood Johnson Medical School, Newark, NJ, and The Medical Center at Princeton, Princeton, NJ 15 Professor of Pediatrics, Tufts-New England Medical Center, Boston, MA 16 Staff Physician, Tifton Medical Clinic, Tifton, GA 17 Senior Investigator, National Institute of Arthritis and Musculoskeletal and Skin Diseases 18 Professor of Medicine, Mayo Medical School and Clinic. 19 From the Rheumatoid Arthritis Criteria Subcommittee of the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. * requests to the American Rheumatism Association, 17 Executive Park Drive, NE, Suite 480, Atlanta, GA 30329

> The revised criteria for the classification of rheumatoid arthritis (RA) were formulated from a computerized analysis of 262 contemporary, consecutively studied patients with RA and 262 control subjects with rheumatic diseases other than RA (non-RA). The new criteria are as follows: 1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement; 2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician; 3) swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints; 4) symmetric swelling (arthritis); 5) rheumatoid nodules; 6) the presence of rheumatoid factor; and 7) radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints. Criteria 1 through 4 must have been present for at least 6 weeks. Rheumatoid arthritis is defined by the presence of 4 or more criteria, and no further qualifications (classic, definite, or probable) or list of exclusions are required. In addition, a “classification tree” schema is presented which performs equally as well as the traditional (4 of 7) format. The new criteria demonstrated 91–94% sensitivity and 89% specificity for RA when compared with non-RA rheumatic disease control subjects.

... 所有病例诊断均符合美国风湿病学会1987年修订的RA分类标准^[3] ...

1995

7.477

0.0

. 1995, 38(1):44-48

Modified disease activity scores that include twenty-eight-joint counts development and validation in a prospective longitudinal study of patients with rheumatoid arthritis

M. L. L. Prevoo MSC 1,* ,M. A. Van'T Hof PhD 2 ,H. H. Kuper MD 3 ,M. A. Van Leeuwen MD 3 ,L. B. A. Van De Putte MD 1 andP. L. C. M. Van Riel MD 1

1 University Hospital Nijmegen, Nijmegen, The Netherlands 2 Nijmegen University, Nijmegen, The Netherlands 3 University Hospital Groningen, Groningen, The Netherlands. * Department of Rheumatology, University Hospital Nijmegen, P. O. Box 9101, 6500 HB Nijmegen, The Netherlands

> Objective. The development and validation of Modified Disease Activity Scores (DAS) that include different 28-joint counts.

... 1和[4]分别统计,结果显示两组间D-二聚体、抗CCP抗体差异有统计学意义(PRA组D-二聚体、抗CCP抗体与临床疾病活动情况的相关性分析显示D-二聚体、抗CCP抗体浓度与DAS28评分呈明显正相关(r值分别为0 ...

2002

0.0

... 血黏度值异常升高使血液呈高凝状态^[5] ,进一步加剧凝血-纤溶系统的紊乱 ...

2012

0.0

... 结果显示RA组抗 CCP抗体、D-二聚体、血黏度值明显高于对照组(P[6,7]中的评价相一致,3项指标的综合判断将有助于类风湿性节炎的早期诊断与病情监测、疗效评估 ...

2013

0.0