Predeteanu Denisa, Varzaru Luminita, Balanescu Andra, Bojinca Violeta, Opris Daniela, Vlad Violeta, Berghea Florian, Abobului Mihai, Constantinescu Cosmin, Ionescu Ruxandra
Department of Internal Medicine and Rheumatology, "Sf Maria" Research Center on Pathology and Treatment of Rheumatic Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
J Med Life. 2009 Jan-Mar;2(1):36-41.
Immunological abnormalities in rheumatoid arthritis (RA) imply several antibodies, among which anti-cyclic cytrullinated peptide antibodies (anti-CCP) have the highest sensitivity and specificity. Their diagnostic and prognostic value in RA is well known, although their value as markers of the disease activity has not been established yet.
The aim of this study is to evaluate the correlation between anti-CCP antibodies and RA activity which eventually leads to the best treatment of choice.
217 consecutive patients hospitalized in the Department of Internal Medicine and Rheumatology, "Sf Maria" Clinical Hospital between 01.01-31.06 2007 were retrospectively studied. They were divided into two groups: group A-111 patients with RA (ACR criteria fulfilled) and group B-106 patients with other rheumatic diseases. The following parameters taken out of the patients files were studied: parameters of the clinical activity of disease (C reactive protein, fibrinogen), rheumatoid factor (RF) and anti-CCP antibodies. Disease activity score (DAS) using 4 variables (number of tender joints, number of swollen joints, erythrocyte sedimentation rate and assessement of the disease activity) was also studied. Data were processed with SPSS program using linear functions, Pearson correlation coefficient and Hi2 test of interdependency.
The sensitivity of anti-CCP antibodies in patients with RA was 56.75%. The specificity of anti-CCP antibodies in patients with RA was 90.56%. Low seric levels of anti-CCP antibodies were also found in patients without RA, but with other conditions like: osteoarthritis, viral polyarthritis, infectious myositis and Still disease; moderate to high seric levels were found in patients with psoriatic arthritis. Significant correlations were found between anti-CCP antibodies and DAS (r = 0.437), between anti-CCP and fibrinogen (r = 0.32) between anti-CCP antibodies and C reactive protein (r = 0.237) as well as between anti-CCP and RF (r = 0.38).
Anti-CCP antibodies are highly specific but moderately sensitive for RA, their highest frequencies and seric levels being found in seropositive RA. Anti-CCP can be used in patients with RA not only as a diagnostic marker but also as a reliable test for assessing the activity of the disease.
类风湿关节炎（RA）中的免疫异常涉及多种抗体，其中抗环瓜氨酸肽抗体（抗CCP）具有最高的敏感性和特异性。其在RA中的诊断和预后价值已广为人知，尽管其作为疾病活动标志物的价值尚未确立。
本研究旨在评估抗CCP抗体与RA活动之间的相关性，最终找到最佳治疗选择。
回顾性研究了2007年1月1日至6月31日期间在“Sf Maria”临床医院内科和风湿病科住院的217例连续患者。他们被分为两组：A组-111例符合美国风湿病学会（ACR）标准的RA患者；B组-106例患有其他风湿性疾病的患者。研究了从患者病历中提取的以下参数：疾病临床活动参数（C反应蛋白、纤维蛋白原）、类风湿因子（RF）和抗CCP抗体。还研究了使用4个变量（压痛关节数、肿胀关节数、红细胞沉降率和疾病活动评估）的疾病活动评分（DAS）。使用线性函数、Pearson相关系数和独立性卡方检验，通过SPSS程序对数据进行处理。
RA患者中抗CCP抗体的敏感性为56.75%。RA患者中抗CCP抗体的特异性为90.56%。在无RA但患有其他疾病如骨关节炎、病毒性多关节炎、感染性肌炎和斯蒂尔病的患者中也发现抗CCP抗体血清水平较低；在银屑病关节炎患者中发现抗CCP抗体血清水平为中度至高度。发现抗CCP抗体与DAS之间存在显著相关性（r = 0.437），抗CCP与纤维蛋白原之间存在显著相关性（r = 0.32），抗CCP抗体与C反应蛋白之间存在显著相关性（r = 0.237），以及抗CCP与RF之间存在显著相关性（r = 0.38）。
抗CCP抗体对RA具有高度特异性但敏感性中等，在血清阳性RA中其出现频率和血清水平最高。抗CCP不仅可作为RA患者的诊断标志物，还可作为评估疾病活动的可靠检测指标。
