【作者】 陈秀敏；

【导师】 黄清春；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2010， 硕士

【摘要】 1目的1.1检测6-磷酸葡萄糖异构酶(GPI)抗原在类风湿性关节炎(RA)患者、非RA自身免疫性疾病患者以及非免疫性疾病患者、健康体检者血清中的浓度,以探讨其在RA诊断中的临床应用价值。1.2探讨血清中GPI、抗环瓜氨酸肽抗体(抗CCP抗体)、抗角质蛋白抗体(AKA)及类风湿因子(RF)4种自身抗体联合检测在RA中的诊断意义。1.3将RA患者血清中GPI与RF、血沉(ESR).C-反应蛋白(CRP)做比较,探讨GPI与各指标之间的相关性。1.4检测20例RA患者治疗前后GPI水平、RF.ESR.CRP的浓度变化,探讨GPI对RA病情变化的反应及复方丹参注射液对GPI的影响。2方法2.1收集符合诊断标准和排除标准的RA患者53例,其他自身免疫性疾病患者35例,非免疫性疾病患者30例,健康体检者60例,采用酶联免疫吸附法定量检测各组血清中的GPI浓度,将结果进行统计学比较。2.2收集符合诊断标准和排除标准的RA患者53例及非RA患者65例,分别采用酶联免疫吸附法检测GPI、抗CCP,间接免疫荧光法检测AKA,免疫速率散射比浊法检测RF,总结出各自身抗体单独检测以及联合检测对RA诊断的敏感性及特异性。2.3收集符合诊断标准和排除标准的RA患者53例,分别采用酶联免疫吸附法检测GPI,免疫速率散射比浊法检测RF.CPR,魏氏法检测ESR,将结果进行统计学比较。2.4收集符合诊断标准和排除标准的RA患者20例,检测治疗前后的GPI水平、RF、ESR. CRP,将治疗前后结果变化进行统计学比较；治疗前后GPI浓度变化与外院GPI浓度变化进行比较。3结果3.1 RA组GPI浓度3.65±2.87 ug/ml,阳性率79.25%,非RA自身免疫病组为0.96±1.74 ug/ml,阳性率40%,非自身免疫病组GPI浓度0.40±0.99 ug/ml,阳性率20%,健康对照组中阳性率5%。RA组GPI水平明显高于其它两组,RA组与非RA自身免疫病组、非自身免疫病组比较有显著性差异(P<0.01)；非RA自身免疫病组与非自身免疫病组比较无统计学差异(P>0.05)。3.2 GPI在RA患者中敏感性79.25%,特异性69.23%,抗CCP 56.6%、96.92%,AKA 32.08%.96.92%,RF 71.7、%89.23%,GPI与抗CCP.RF和/或AKA联合检测则阳性率提高到88.68%,特异性高达98.46%。3.3 GPI与RF相比,r值为0.6527,P<0.01,两者之间有显著相关性；而GPI与血沉、C-反应蛋白相比均无相关性(P>0.05)。3.4 20例RA患者经治疗后主要症状较前明显改善,治疗前后GPI水平、RF、血沉、C-反应蛋白比较均无显著性差异；治疗后GPI含量有下降趋势但无统计学意义,与外院研究结果无显著差异。4结论4.1 GPI抗原的检测在RA临床诊断、鉴别诊断中具有一定的价值,很可能成为RA临床诊断的一个新指标。4.2 GPI、抗CCP、AKA、RF4种抗体联合检测对RA有较高的敏感性和特异性,可提高RA的诊断率。4.3 GPI与RF有显著相关性,由于RF对RA活动性判断有明确的意义,由此推断GPI对RA的诊断及活动性的判断有很大的临床应用价值,有可能和CRP一样,成为RA活动的指标之一4.4本研究结果显示GPI与RA疗效无显著相关性,对RA疗效评价意义不大；经复方丹参注射液治疗后患者血清中GPI阳性率明显降低且含量有降低趋势,复方丹参注射液对GPI有一定的影响。更多还原

【Abstract】 1 Objects1.1 To study serum glucose-6 phosphate isomerase(GPI) level from RA patients, other rheumatologic patients, non-rheumatologic patients and healthy controls. Discuss the role of glucose-6 phosphate isomerase in diagnosis of RA.1.2 To assess the diagnostic significance of serum GPI, anti-Cyclic Citrullinated Peptide antibody(anti-CCP), anti-keratin antibody(AKA) and rheumatoid factor(RF) in the diagnosis of RA.1.3 To compare serum GPI, RF, erythrocyte sedimentation rate(ESR), C-reative protein(CRP) of RA patients. Evaluate the relationship among GPI and other factors.1.4 To study the variation of GPI,RF, ESR, CRP before and after treatment. Evaluate the role of GPI in curative effect evaluation of RA. Evaluate the effect of compound salvia m iltiorrhizal injection on GPI.2 Methods2.1 Used Enzyme-Linked Immuno Sorbent Assay to exam serum GPI level from 53 RA patients,35 other rheumatologic patients,30·non-rheumatologic patients and 60 healthy controls.The result of this study was compared.2.2 Used Enzyme-Linked Immuno Sorbent Assay to exam serum GPI level, anti-CCP, used indirect immunofluoresent assay to exam AKA, used turbidimetric immunoassay method to exam RF from 53 patients of RA. Sum up the sensitivity and specificity for diagnosis of RA.2.3 Used Enzyme-Linked Immuno Sorbent Assay to exam serum GPI level,used turbidimetric immunoassay method to exam RF and CRP, used westergren to exam ESR from 53 patients of RA. Sum up and compare the result.2.4 To exam serum GPI level, RF, ESR, CRP from 20 patients of RA before and after the treatment and compare the result. To compare serum GPI level before and after the treatment with othe hospital.3 Results3.1 Serum GPI level and the GPI positive rate from RA patients were 3.65±2.87ug/ml and 79.25%, from other rheumatologic patients were 0.96±1.74ug/ml and 40%, from non-rheumatologic patients were 0.40±0.99ug/ml and 20%. The GPI positive rate from healthy controls was 5%. Serum GPI level from RA patients was significantly higher than those from other rheumatologic patients and non-rheumatologic patients. There were significant difference among RA patients and other rheumatologic patients, non-rheumatologic patients. There were no difference between rheumatologic patients and non-rheumatologic patients.3.2 The sensitivity and specificity of GPI for diagnosis of RA were 79.25% and 69.23%;anti-CCP were 56.6% and 96.92%; AKA were 32.0% and 96.92%; RF were 71.7% and 89.23%. The sensitivity and specificity of the combined detection of GPI,anti-CCP and RF and/or AKA were 88.68% and 100%.3.3 Compared with RF, the r value was 0.6527. There were significant relationship between GPI and RF (P<0.01). While there were no relationship among GPI and ESR、CRP(P>0.05).3.4 The main clinical symptoms of the 20 RA patients were improved significantly after the treatment. Serum GPI level, ESR and CRP had no difference between before and after the treatment. Serum GPI level was degraded significantly but was conformity. Compared with other clinical research, the changement of serum GPI level was conformity.4 Conclusions4.1 GPI holds great promise as a diagnosis and differential diagnosis tool for RA. It may be a new index for diagnosis of RA.4.2 The combined detection of GPI, anti-CCP, AKA and RF have high sensitivity and specificity in diagnosis of RA. Thus the combined detection of these four antibodies may help the diagnosis of RA.4.3 GPI is shown to be significantly related to RF. RF plays a great role on the activity of RA. Thus, GPI holds great promise as a diagnosis tool for RA and its activity. It may be one of the index for activity of RA such as CRP.4.4 GPI is not shown to be significantly related in curative effect evaluation to RA. The GPI positive rate and serum GPI level from 20 RA patients is degraded significantly after the treatment of compound salvia m iltiorrhizal injection. Compound salvia m iltiorrhizal injection has certain impact on GPI.更多还原