Department of Internal Medicine, Seoul National University, College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
Rheumatol Int. 2011 Mar;31(3):315-9. doi: 10.1007/s00296-009-1260-5. Epub 2009 Dec 15.
The purpose of this study was to investigate the diagnostic utilities of anti-agalactosyl IgG antibody (CARF), anti-cyclic citrullinated peptide (CCP) antibody and rheumatoid factor (RF) in rheumatoid arthritis (RA), non-RA rheumatic diseases, and chronic viral hepatitis. The authors determined serum levels of CARF and anti-CCP2 by ELISA and IgM-RF by a immunonephelometric method in 834 controls and in 397 patients with the following conditions: RA (100), non-RA rheumatic diseases [systemic lupus erythematosus (SLE) 30, primary Sjogren's syndrome 18, systemic sclerosis 30, inflammatory myositis 19], chronic viral hepatitis B and C (HBV 100, HCV 100). The sensitivities of CARF (83%) and anti-CCP (85%) were significantly higher than that of RF (75%, p = 0.01, respectively) in RA, and the specificity of anti-CCP (98%) was significantly higher than those of CARF (92%) and RF (90%, p < 0.001, respectively). A comparison of receiver operating characteristic (ROC) curves revealed that the diagnostic accuracies of CARF and anti-CCP were superior to that of RF (CARF vs. RF, p = 0.008, anti-CCP vs. RF, p = 0.017) in RA. CARF positivity was significantly higher than those of anti-CCP (p = 0.007) and RF (p = 0.008) in systemic sclerosis, and the positivity of CARF was significantly higher than that of anti-CCP in Sjogren's syndrome (p = 0.016). Furthermore, CARF had significantly higher positivity than anti-CCP or RF in chronic viral hepatitis B and C. Finally, the titers of these three markers in RA were significantly higher than in non-RA rheumatic diseases and in chronic viral hepatitis B and C. Our results suggest that anti-CCP is the most useful serologic marker for the differentiation of RA and non-RA rheumatic diseases, and chronic viral hepatitis B and C.
本研究旨在探讨抗半乳糖 IgG 抗体（CARF）、抗环瓜氨酸肽（CCP）抗体和类风湿因子（RF）在类风湿关节炎（RA）、非 RA 风湿性疾病和慢性病毒性肝炎中的诊断效用。作者通过 ELISA 法测定了 834 例对照者和 397 例患者的血清 CARF 和抗 CCP2 水平，通过免疫散射比浊法测定了 IgM-RF。这些患者的疾病情况如下：RA（100 例）、非 RA 风湿性疾病[系统性红斑狼疮（SLE）30 例、原发性干燥综合征 18 例、系统性硬化症 30 例、炎性肌病 19 例]、慢性乙型和丙型病毒性肝炎（HBV 100 例、HCV 100 例）。在 RA 中，CARF（83%）和抗 CCP（85%）的敏感性明显高于 RF（75%，p=0.01），抗 CCP 的特异性（98%）明显高于 CARF（92%）和 RF（90%，p<0.001）。受试者工作特征（ROC）曲线比较显示，在 RA 中，CARF 和抗 CCP 的诊断准确性优于 RF（CARF 与 RF，p=0.008，抗 CCP 与 RF，p=0.017）。CARF 的阳性率明显高于系统性硬化症中的抗 CCP（p=0.007）和 RF（p=0.008），CARF 的阳性率明显高于干燥综合征中的抗 CCP（p=0.016）。此外，CARF 在慢性乙型和丙型病毒性肝炎中的阳性率明显高于抗 CCP 或 RF。最后，RA 中这三种标志物的滴度明显高于非 RA 风湿性疾病和慢性乙型和丙型病毒性肝炎。我们的研究结果表明，抗 CCP 是区分 RA 和非 RA 风湿性疾病以及慢性乙型和丙型病毒性肝炎的最有用的血清学标志物。
