- 期刊
抗環瓜氨酸肽抗體與類風濕因子在健檢民眾肌肉骨骼疾病的相對重要性
The Relative Importance of Anti-cyclic Cirtrullinated Peptide and Rheumatoid Factor on Musculoskeletal Disease among Health Examination Participants
摘要
早期只有類風濕因子(rheumatoid factor, RF)可用來輔助診斷類風濕性關節炎(rheumatoid arthritis, RA)，但其靈敏度與特異性皆不足。目前認爲抗環瓜氨酸肽抗體(anti-cyclic citrullinated peptide, anti-CCP)對RA不僅具有高靈敏度與特異性，且可在症狀出現前便存在，也可預測疾病的預後，但卻很少運用在健檢病人。爲了評估anti-CCP是否能取代RF，成爲40歲以上成人健檢中RA的輔助檢查，本研究收集了101位40歲以上健檢民眾（平均值±標準差：63.40±12.24歲，範圍爲：41到87歲）的血清，並測量其體內anti-CCP與RF濃度。研究發現在健檢民眾中，anti-CCP陽性有24位(23.8%)，RF陽性10位(9.9%)，兩者皆呈陽性4人(4.0%)，兩者皆陰性爲71位(70.3%)，且anti-CCP濃度與RF濃度無關（spearman相關係數0.12，P值0.22）。這些健檢民眾的anti-CCP濃度爲8.61±15.04U/ml，最低0.11U/ml，最高爲85.2U/ml；24位anti-CCP陽性者，其anti-CCP濃度爲30.65±17.76U/ml；在91位RF陰性民眾中，有20位(22%)anti-CCP陽性（濃度爲29.75±18.86U/ml），而在10位RF陽性受檢者中，有4位anti-CCP陽性（濃度爲35.18±11.53U/ml）。卡方檢定指出這些健檢民眾的anti-CCP與RF之間並無相關（P值爲0.20）。另外，本研究發現在這101位健檢民眾中，anti-CCP及RF與年齡跟性別都沒有顯著相關性，但有骨頭關節病變史的民眾（20位，其中11位anti-CCP陽性）較沒有骨頭關節病變史者（81位，其中13位anti-CCP陽性）有較高的平均anti-CCP濃度（21.45 v.s. 5.44U/ml，P值0.0077）。卡方檢定亦顯示骨頭關節病變史與anti-CCP間有極顯著相關性（P值＜＝0.001），但與RF並沒有相關性。此研究發現anti-CCP可存在於近1/4的40歲以上健檢民眾，有骨頭關節病變史的患者有顯著較高的anti-CCP濃度，且anti-CCP異常的比例更可高達55%。由於anti-CCP對類風濕性關節炎的高靈敏度與高特異性，我們建議anti-CCP可當做健檢民眾的篩檢檢查，尤其是在那些有骨頭關節病變史的患者。
並列摘要
To examine the role of anti-cyclic cirtrullinated peptide (anti-CCP) in health examination in subjects equal to or older than 40 years old. Method: Serum concentration of anti-CCP and rheumatoid factor (RF) from 101 participants (mean age ± S.D: 63.40±12.24, range: 41 to 87 years) were measured and correlated with the clinical condition. Results: Among the study group, the mean anti-CCP concentration was 8.61±15.04 U/ml and 24 person (23.8%) were anti-CCP positive (mean ± S.D: 30.65±17.76 U/ml). Moreover, among the 91 RF-negative subjects, 22% were anti-CCP positive (mean ± S.D: 29.75±18.86 U/ml). Anti-CCP or RF was not related to the age or gender, but anti-CCP concentration was significant higher in 20 subjects with a history of musculoskeletal disease (55% anti-CCP positive) than in 81 subjects (16.0% anti-CCP positive) without musculoskeletal diseases (21.45±23.73 U/ml v. s. 5.44±9.88 U/ml, p=0.0077). Chi-square test also revealed that anti-CCP, but not RF, was significantly associated with the history of musculoskeletal disease. Conclusion: anti-CCP might be existed in about 1/4 of subjects equal to or older than 40 years old during their routine health checkup. We suggest that anti-CCP might be used as a screening test in this population, especially on those with musculoskeletal symptoms.