Ribeiro S L E, Pereira H L A, Silva N P, Neves R M S, Sato E I
Disciplina de Reumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Braz J Med Biol Res. 2008 Nov;41(11):1005-10. doi: 10.1590/s0100-879x2008001100010.
The objective of the present research was to evaluate the usefulness of anti-cyclic citrullinated peptide (anti-CCP) antibodies and the IgM rheumatoid factor (IgM RF) test for the differential diagnosis of leprosy with articular involvement and rheumatoid arthritis (RA). Anti-CCP antibodies and IgM RF were measured in the sera of 158 leprosy patients (76 with and 82 without articular involvement), 69 RA patients and 89 healthy controls. Leprosy diagnosis was performed according to Ridley and Jopling classification criteria and clinical and demographic characteristics of leprosy patients were collected by a standard questionnaire. Leprosy patients with any concomitant rheumatic disease were excluded. Serum samples were obtained from all participants and frozen at -20 degrees C. Measurement of anti-CCP antibodies and IgM RF were performed by ELISA, using a commercial second-generation kit, and the latex agglutination test, respectively. Anti-CCP antibodies and IgM RF were detected in low frequencies (2.6 and 1.3%, respectively) in leprosy patients and were not associated with articular involvement. Among healthy individuals both anti-CCP antibodies and IgM RF were each detected in 3.4% of the subjects. In contrast, in the RA group, anti-CCP antibodies were present in 81.2% and IgM RF in 62.3%. In the present study, both anti-CCP antibodies and IgM RF showed good positive predictive value for RA, helping to discriminate between RA and leprosy patients with articular involvement. However, anti-CCP antibodies were more specific for RA diagnosis in the population under study.
本研究的目的是评估抗环瓜氨酸肽（抗CCP）抗体和IgM类风湿因子（IgM RF）检测在鉴别诊断伴有关节受累的麻风病和类风湿关节炎（RA）中的作用。检测了158例麻风病患者（76例有关节受累，82例无关节受累）、69例RA患者和89例健康对照者血清中的抗CCP抗体和IgM RF。根据里德利和乔普林分类标准进行麻风病诊断，并通过标准问卷收集麻风病患者的临床和人口统计学特征。排除患有任何合并风湿性疾病的麻风病患者。从所有参与者中采集血清样本，并在-20℃下冷冻。分别采用商业第二代试剂盒通过ELISA法和乳胶凝集试验检测抗CCP抗体和IgM RF。麻风病患者中抗CCP抗体和IgM RF的检出频率较低（分别为2.6%和1.3%），且与关节受累无关。在健康个体中，抗CCP抗体和IgM RF的检出率均为3.4%。相比之下，在RA组中，抗CCP抗体的阳性率为81.2%，IgM RF的阳性率为62.3%。在本研究中，抗CCP抗体和IgM RF对RA均显示出良好的阳性预测价值，有助于鉴别RA和伴有关节受累的麻风病患者。然而，在所研究的人群中，抗CCP抗体对RA诊断更具特异性。
