Rashid Taha, Ebringer Alan, Wilson Clyde, Bansal Sukvinder, Paimela Leena, Binder Allan
Division of Health and Life Sciences and the Department of Pharmacy, King's College London, and the Department of Rheumatology, University College Medical School, Middlesex Hospital, London, UK.
J Clin Rheumatol. 2006 Feb;12(1):11-6. doi: 10.1097/01.rhu.0000200374.14619.f2.
Both rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are potentially disabling arthritic disorders for which as yet no highly sensitive and reliable diagnostic laboratory markers are available.
The objective of this study was to evaluate the levels of antibodies against Proteus and Klebsiella antigenic peptides in an endeavor to develop diagnostic indices for the identification of patients with RA and AS, respectively.
Sera from 50 patients with RA, 34 patients with AS, and 38 healthy subjects were screened for antibodies against "ESRRAL" and "IRRET" synthetic amino acid peptides obtained from Proteus hemolysin and urease (HU) as well as against "QTDRED" and "DRDE" peptides from Klebsiella nitrogenase and pullulanase (NP) proteins, respectively. Multiplication of the 2 antibodies against each organism produced indices for RA-HU and AS-NP.
Significantly increased levels of anti-HU antibodies (P<0.0001) were observed in patients with RA when compared with patients with AS or with healthy control subjects. Patients with AS were found to have significantly elevated levels of anti-NP (P<0.0001) antibodies when compared with patients with RA or with healthy subjects. Furthermore, all patients with RA were found to have values of anti-HU antibody (RA-HU) index above 95% confidence limit (CL) of the mean of healthy control subjects; meanwhile, all patients with AS were having values of anti-NP antibody (AS-NP) index above the 95% CL of the mean of healthy control subjects (100% sensitivity). However, the specificity of the RA-HU index in RA and the AS-NP index in patients with AS were 92% and 95%, respectively.
The use of the RA-HU or AS-NP diagnostic index as a sole marker or in combination with other autoantibody markers could be used in the identification of patients with RA or AS, respectively. Longitudinal investigations starting with patients with early disease will be needed.
类风湿关节炎（RA）和强直性脊柱炎（AS）均为可能导致残疾的关节炎性疾病，目前尚无高度敏感且可靠的诊断性实验室标志物。
本研究旨在评估抗变形杆菌和克雷伯菌抗原肽抗体水平，以期分别建立用于识别RA和AS患者的诊断指标。
对50例RA患者、34例AS患者和38名健康受试者的血清进行筛查，分别检测其针对从变形杆菌溶血素和脲酶（HU）获得的“ESRRAL”和“IRRET”合成氨基酸肽的抗体，以及针对从克雷伯菌固氮酶和支链淀粉酶（NP）蛋白获得的“QTDRED”和“DRDE”肽的抗体。两种针对每种微生物的抗体相乘得出RA - HU和AS - NP指标。
与AS患者或健康对照受试者相比，RA患者中抗HU抗体水平显著升高（P<0.0001）。与RA患者或健康受试者相比发现，AS患者中抗NP抗体水平显著升高（P<0.0001）。此外，发现所有RA患者的抗HU抗体（RA - HU）指标值均高于健康对照受试者均值的95%置信区间（CL）；同时，所有AS患者的抗NP抗体（AS - NP）指标值均高于健康对照受试者均值的95%CL（敏感性100%）。然而，RA - HU指标在RA中的特异性以及AS - NP指标在AS患者中的特异性分别为92%和95%。
RA - HU或AS - NP诊断指标单独使用或与其他自身抗体标志物联合使用，可分别用于识别RA或AS患者。需要对早期疾病患者开展纵向研究。
