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題 名 | The Role of Synovial Fluid Levels of Anti-cyclic Citrullinated Peptide Antibodies in Differential Diagnosis of Arthritis=關節液內的抗環狀瓜氨酸抗體濃度在關節炎鑑別診斷的角色 |
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作 者 | 王立峰; 林新田; 呂聆音; 胡瑞潔; 曾瑞成; 楊燦; 高堅凱; | 書刊名 | 中華民國風濕病雜誌 |
卷 期 | 21:2 2007.12[民96.12] |
頁 次 | 頁46-52 |
分類號 | 415.695 |
關鍵詞 | 抗環狀瓜氨酸抗體; 關節液; 類風濕因子; 類風濕性關節炎; Anti-CCP antibody; Synovial fluid; Rheumatoid factor; Rheumatoid arthritis; |
語 文 | 英文(English) |
中文摘要 | 目的:評估關節液抗瓜氨酸抗體濃度在關節炎鑑別診斷上的效用,並分析此抗體與血中的抗瓜氨酸抗體與類風濕因子濃度,及關節液中白血球數量的關係。 方法:從單一醫學中心的關節炎門診患者中收集 191 個關節液檢體,分析其中的抗瓜氨酸抗體濃度與白血球數目與分類,類風濕性關節炎患者則加作血中的抗瓜氨酸抗體與類風濕因子濃度。 結果:在退化性關節炎、血清陰性脊椎關節炎、痛風、貝塞特氏症、全身性紅斑狼瘡、結晶性關節炎、感染性關節炎、骨缺血性壞死、色素沉著性滑液膜結節絨毛樣增生與待分類結締組織疾患患者的關節液中,只有一例痛風患者抗瓜氨酸抗體濃度異常(2%, 1/57) ,其餘皆在正常值範圍內。類風濕性關節炎患者的關節液中,抗瓜氨酸抗體濃度顯著高於其他關節炎的檢體(p<0.0001)。關節液抗瓜氨酸抗體濃度、血中的抗瓜氨酸抗體與類風濕因子濃度在類風濕性關節炎患者中的陽性率分別為79% (34/43) 、83.7% (36/43) 及72.1% (31/43)。關節液抗瓜氨酸抗體濃度在診斷類風濕性關節炎上,可達理想的敏感度(79%) 與優異的特異性(99.5%)。在類風濕性關節炎患者中,關節液抗瓜氨酸抗體濃度和血中的抗瓜氨酸抗體有強正相關(p<0.001),和類風濕因子濃度有弱正相關 (p<0.05) ,但和關節液中白血球數量,不管是多核球或單核球,都不相關。 結論:關節液抗瓜氨酸抗體濃度和血中的抗瓜氨酸抗體一樣,在診斷類風濕性關節炎具有高特異性,且其關節液中的濃度與血中的濃度呈強正相關,和血中類風濕因子濃度呈弱正相關,但和關節液中的多核球數量不相關,這和文獻上所提,多核球可促進蛋白質瓜氨酸化,並誘發抗體反應的說法有出入。 |
英文摘要 | Objectives: To determine the usefulness of anti-cyclic citrullinated peptide antibodies (anti-CCP) in synovial fluid (sfCCP) for differential diagnosis of variable arthropathies, and to analyze the correlations with anti-CCP and rheumatoid factor (RF) in serum as well as white blood cells (WBC) counts in synovial fluid. Methods: 191 synovial fluid samples were tested for WBC counts and anti-CCP using anti-CCP2 assays. Sera of the 43 patients with rheumatoid arthritis (RA) were additionally tested for anti-CCP (smCCP) and RF. Results: The sfCCP levels were within the normal limit in patients with osteoarthritis, seronegative spondyloarthropathy, gout, Behcet’s disease, systemic lupus erythematosus, CPPD disease, infection, osteonecrosis, pigmented villonodular synovitis and undifferentiated connective tissue disease, except one with gout (1/57, 2%). The sfCCP of RA patients were distinctively higher than those in other arthritis groups (p<0.0001). The positive rate of sfCCP, smCCP and RF in serum in RA patients was 79% (34/43), 83.7% (36/43) and 72.1% (31/43), respectively. In RA patients, sfCCP was strongly correlated with smCCP (p<0.001), RF moderately (p<0.05), but not correlated with total WBC, polymorphonuclear cell or mononuclear cell counts in synovial fluid. Conclusion: sfCCP is highly specific for RA, and is closely related to smCCP and RF, but not correlated to the numbers of PMN, which are considered to offer peptidyl-arginine deiminase 4 and induce citrullinated protein formation in the murine model. |
本系統中英文摘要資訊取自各篇刊載內容。