抗环瓜氨酸肽抗体滴度变化与类风湿关节炎患者达标和复发的相关性研究

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目的:探究抗CCP抗体滴度与RA疾病活动度、达标和复发的相关性。方法:选取北京大学第一医院风湿免疫科RA随访队列中的患者,入组患者需在我院首次就诊时抗CCP抗体阳性,且间隔至少1年随访过程中有至少1次抗CCP抗体复查结果。根据随访过程中抗CCP抗体滴度自基线下降是否超过10%,将患者分为下降组和未下降组,采用单因素比较、Spearman及Kendall相关性分析对抗CCP抗体滴度与疾病活动度、是否缓解及复发进行相关性分析。结果:本研究共纳入124例患者,女性105例(84.7%),中位年龄51.5(38.3,58.0)岁,中位病程24(5,84)个月,中位随访时间24(14,57.8)个月,其中抗CCP抗体滴度下降组65例,未下降组59例。基线抗CCP抗体滴度与基线疾病活动度指标,包括压痛关节数(TJC)、肿胀关节数、ESR、CRP、患者对疾病的总体评价(PGA)、医生对疾病的总体评价(EGA)、基于28关节计数和CRP/ESR的疾病活动度评分(DAS28-CRP/DAS28-ESR)、简化的疾病活动度指标(SDAI)、临床疾病活动度指标(CDAI)之间未见相关性(n r值均0.05);随访过程中抗CCP滴度的变化与疾病活动度的变化无相关性(但n r值均<0.3,n P均<0.05)。至随访终点时,DAS28-CRP、DAS28-ESR、TJC及CRP变化值在抗CCP滴度下降组显著高于未下降组(n P均<0.05);抗CCP抗体滴度下降组和未下降组患者达到临床缓解/低疾病活动度的比例分别为78%(51/65)和68%(40/59),随访中抗CCP抗体滴度是否下降与随后能否达标无相关性(n r=0.121,n P=0.181),也与疾病复发无相关性(n r=-0.112,n P=0.216)。基线抗CCP抗体水平与随访终点时患者临床上是否达标以及是否出现疾病复发之间也不存在相关性(n r绝对值均<0.3,n P值分别为0.465及0.108)。n 结论:基线抗CCP抗体水平以及随访过程中滴度的变化均与基线疾病活动度、治疗后是否达到治疗目标以及是否复发之间无相关性,其在评估疾病活动度、预测治疗反应以及复发方面的价值有待进一步大规模、前瞻性研究证实。“,”Objective:Anti-cyclic citrullinated peptide (CCP) antibody is an important biomarker as-sociated with the diagnosis and prognosis of rheumatoid arthritis (RA). Different studies showed inconsistency in the relationship between anti-CCP antibody titers and RA disease activity. Therefore, we investigated the association between anti-CCP antibody with the possibility of achieving treatment target and flare.Methods:The enrolled RA patients must be anti-CCP antibody positive at baseline, and had at least one test result of anti-CCP antibody during follow-up at least one year after the baseline. The patients were divided into declined group and non-declined group according to the decrease of anti-CCP antibody titer over 10% or not during follow-up from the baseline. Single factor comparison, Pearson correlation, Spearman correlation and Kendall correlation analysis were used.Results:A total of 124 patients were included in this study. Sixty-five and 59 patients were in anti-CCP antibody declined and non-declined groups, respectively. At the end of the follow-up, the proportion of patients who achieved clinical remission or low disease activity were 78%(51/65) and 68% (40/59)in the declined and the non-declined groups, respectively (n P=0.181). The changes of Disease Activity Score with 28 joint (DAS28)-C-reaction protein (CRP), DAS28-erythrocyte sedimentation rate (ESR), tender joint count (TJC) and CRP in the declined group were significantly greater than those of the non-declined group (n P values <0.05). There was no positive correlation between anti-CCP antibody titer and several disease activity indicators at baseline ( n r values 0.05). The changes of anti-CCP antibody titers during the follow-up were also not correlated with changes in disease activity (but n r values <0.3, n P values <0.05). Meanwhile, both the baseline anti-CCP antibody titers and the changes of the anti-CCP antibody titers during follow-up were neither correlated with whether the patient achieved clinical remission or low disease activity at the end of the follow-up nor whether relapse happened.n Conclusion:There is no significant correlation between anti-CCP antibody levels at baseline and disease activity, achievement of treatment target, or recurrence after treatment. The value of anti-CCP antibody in assessing disease activity, predicting treatment response, and predicting relapse needs to be confirmed in further large-scale prospective studies.
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