葡萄糖-6-磷酸异构酶水平测定与类风湿关节炎早期诊断

doi:10.3969/j.issn.1671-167X.2016.06.004

北京大学学报(医学版) ›› 2016, Vol. 48 ›› Issue (6): 942-946. doi: 10.3969/j.issn.1671-167X.2016.06.004

葡萄糖-6-磷酸异构酶水平测定与类风湿关节炎早期诊断

徐婧1，2*，刘婧1*，朱雷1，张学武1，栗占国1△

（1. 北京大学人民医院风湿免疫科，风湿病机制及免疫诊断北京市重点实验室，北大清华生命科学联合中心，北京 100044；2. 北京大学国际医院风湿免疫科，北京 102206）

出版日期:2016-12-18 发布日期:2016-12-18
通讯作者: 栗占国 E-mail:li99@bjmu.edu.cn
基金资助:
国家自然科学基金（31530020,81120108020）和北京市自然科学基金（7131015）资助

Significance of glucose-6-phosphate isomerase assay in early diagnosis of rheumatoid arthritis

XU Jing1，2*, LIU Jing1* , ZHU Lei1, ZHANG Xuewu1, LI Zhanguo1△

(1.Department of Rheumatology and Immunology, Perking University People’s Hospital, Key Laboratory for Rheumatism Mechanism and Immune Diagnosis, PekingTsinghua Center for Life Sciences, Beijing 100044, China; 2.Department of Rheumatology and Immunology, Perking University International Hospital, Beijing 102206, China)

Online:2016-12-18 Published:2016-12-18
Contact: LI Zhan-guo E-mail:li99@bjmu.edu.cn
Supported by:
Supported by the National Natural Science Foundation of China (31530020, 81120108020) and Beijing Natural Sciece Foundation (7131015)

摘要/Abstract

摘要：

目的：探索葡萄糖-6-磷酸异构酶（glucose-6-phosphate isomerase，GPI）水平测定对于日常门诊中类风湿关节炎（rheumatoid arthritis，RA）早期诊断的意义，及其与RA疾病活动度的相关性。方法：选择2010年至2012年北京大学人民医院风湿免疫科门诊中有多关节肿痛表现的关节炎患者1 051例，选取健康人90例作为对照，ELISA法检测其血清GPI水平，根据临床特点及辅助检查，符合类风湿关节炎分类标准的RA患者525例，其余患者包括骨关节炎（osteoarthritis, OA）患者134例、血清阴性脊柱关节病（seronegative spine joint disease, SpA）患者104例、系统性红斑狼疮（systemic lupus erythematosus, SLE）患者31例、原发性干燥综合征（primary Sj-gren syndrome, pSS）患者24例、痛风（gout arthritis，GA）患者22例、其他结缔组织病（包括风湿性多肌痛、皮肌炎、系统性硬化症、成人Still病等）患者46例、其他疾病（包括骨质疏松、股骨头坏死、骨髓炎、外伤所致骨和关节疾病、幼年类风湿关节炎、肿瘤等）患者165例。评估GPI的诊断价值，分析GPI阳性与阴性组RA患者在临床特点、疾病活动性、严重程度及炎性指标的差别。结果： RA患者中血清GPI的阳性率达55.4%（而其他自身免疫病为14.3%，健康对照组为7.78%，P＜0.001），相较于OA及SpA患者RA患者组滴度显著升高，差异具有统计学意义（P<0.001）。单独应用GPI诊断RA的最佳界值为0.39 mg/L，敏感性54.2%，特异性87.3%。RF阴性患者中GPI阳性率为36.1%；抗环瓜氨酸肽（cyclic citrullinated peptide, CCP)抗体阴性患者中GPI阳性率34.2%； RF和抗CCP抗体双阴性患者中GPI阳性率为24.1%。GPI水平与ESR、 RF、抗CCP抗体及HRFIgG滴度呈正相关（P＜0.05）。结论： GPI在RA患者中有较高的敏感性，抗CCP抗体和/或RF阴性患者中GPI阳性对RA有一定的诊断意义,GPI滴度与RA的疾病活动度可能有关。

关键词: 关节炎, 类风湿, 自身抗体, 葡萄糖-6-磷酸异构酶

Abstract:

Objective： To explore the titer of glucose-6-phosphate isomerase (GPI) for early diagnosis of the outpatient with rheumatoid arthritis (RA) in real life, and to analyze its relationship with disease activity. Methods: In the study, 1 051 patients with arthritis were collected in the group who had joints tender and swelling, and 90 cases of healthy people as a control group. ELISA method was used to detect the serum level of GPI, and according to clinical features and laboratory test, all the patients including 525 RA patients, the other patients including osteoarthritis (OA), 134 cases of seronegative spine joint disease (SpA), 104 cases of systemic lupus erythematosus (SLE), 31 cases of primary Sj-gren syndrome (pSS), 24 cases of gout arthritis (GA), 22 cases of other connective tissue diseases (including polymyalgia rheumatica, dermatomyositis, systemic sclerosis, adult Still disease) and 46 cases of other diseases (including 165 cases of osteoporosis, avascular necrosis of the femoral head, traumatic osteomyelitis, bone and joint disease, juvenile rheumatoid arthritis, tumor). The diagnostic values of GPI were assessed, and the differences between the GPI positive and negative groups of the RA patients in clinical characteristics, disease activity, severity and inflammatory index analyzed. Results: The positive rate of serum GPI in the patients with RA was 55.4%, contrasting to other autoimmune diseases (14.3%) and healthy controls (7.78%)(P<0.001). Compared with the OA and SpA patients, the RA group was increased more significantly, and the difference was statistically significant (P<0.001). The diagnostic value of GPI alone for RA was 0.39 mg/L, the sensitivity was 54.2%, and specificity was 87.3%. The positive rate of GPI in RF negative patients was 36.1%; the positive rate of GPI in anti-CCP antibody negative patients was 34.2%; the positive rate of GPI in RF and anti-CCP antibody negative patients was 24.1%. The level of GPI had positive correlation (P<0.05) with ESR, RF, anti-CCP antibody and HRFIgG. Conclusion: GPI is sensitive in the patients with RA; GPI positive is important in the diagnosis of RA with antiCCP antibody and/or RF negative patients. The titer of GPI is related with disease activity of RA.

Key words: Arthritis, rheumatoid, Autoantibodies, Glucose-6-phosphate isomerase

中图分类号:

R593.2

徐婧，刘婧，朱雷，张学武，栗占国. 葡萄糖-6-磷酸异构酶水平测定与类风湿关节炎早期诊断[J]. 北京大学学报(医学版), 2016, 48(6): 942-946.

XU Jing, LIU Jing,ZHU Lei, ZHANG Xue-wu, LI Zhan-guo. Significance of glucose-6-phosphate isomerase assay in early diagnosis of rheumatoid arthritis[J]. Journal of Peking University(Health Sciences), 2016, 48(6): 942-946.

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葡萄糖-6-磷酸异构酶水平测定与类风湿关节炎早期诊断

Significance of glucose-6-phosphate isomerase assay in early diagnosis of rheumatoid arthritis

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