抗角蛋白抗体在风湿性多肌痛及老年类风湿关节炎鉴别诊断中意义.docVIP

抗角蛋白抗体在风湿性多肌痛及老年类风湿关节炎鉴别诊断中意义 　【关键词】 ,类风湿性关节炎；,,抗角蛋白抗体；,,风湿性多肌痛 　　摘要：目的：探讨抗角蛋白抗体在风湿性多肌痛与老年发病类风湿关节炎鉴别诊断中的意义。方法：以Wistar大鼠中1/3食管组织冰冻切片为底物,采用间接免疫荧光法检测50例老年类风湿性关节炎及30例风湿性多肌痛患者的血清抗角蛋白抗体。结果：50例老年类风湿性关节炎患者中，29例血清抗角蛋白抗体阳性，而在30例风湿性多肌痛患者中，仅7例患者的血清抗角蛋白抗体阳性，两者比较有统计学意义。随访观观察8个月至3.5年,7例血清抗角蛋白抗体阳性的患者中,有5例修正诊断为老年类风湿性关节炎,而在23例血清抗角蛋白抗体阴性的患者中,仅1例修正诊断为老年类风湿性关节炎, 两者比较有统计学意义。结论：血清抗角蛋白抗体可能是一种诊断老年类风湿性关节炎特异性抗体;血清抗角蛋白抗体阳性且具风湿性多肌痛症状的患者也许是早期老年类风湿性关节炎患者。 　　关键词： 类风湿性关节炎； 抗角蛋白抗体； 风湿性多肌痛 　　The Value of AKA Assessment in Distinguishing Polymyalgia Rheumatica from Early Elderly onset Rheumatoid Arthritis 　　　Abstract： Objective：To determine the significance of antikeratin antibody(AKA) in distinguishing polymyalgia rheumatica(PMR) from early elderly onset rheumatoid arthritis(EORA).　Method: Serum samples from 50 EORA patients and 30 PMR patients were studied for the presence of antikeratin antibody with indirect immunofluo-rescene technique using the middle third esophagus of wistar rat as antigen substrate. Result: Fifty-eight percent of EORA patients had AKA Abs, whereas twenty-three of the PMR patients was positive for the antibody. Comparison of PMR and EORA patients showed significant difference in the presence of antikeratin antibody. After a mean follow-up of 1.8±1.1 years, of 7 PMR patients with positive results of AKA, 5 patients developed EORA, Only 1 patient developed EORA in 23 PMR negative patients with results of AKA.There weer significant difference between between the AKA positive and negative patients.Conclusion: AKA is a valuable diagnostic tool for EORA,especially for early EORA. The presence of antikeratin antibody in a patient with clinical symptoms of PMR must be interpreted as highly suggestive of EORA. 　　Key words： Rheumatoid arthritis; Antikeratin antibody; Polymyalgia rheumatica 　　 　　风湿性多肌痛(polymyalgia rheumatica, PMR) 是病因不明的炎症性疾病。部分老年发病类风湿关节炎 (elderly-onset rheumatoid arthritis, EORA) 患者存在 PMR 样临床表现, 有时与 PMR 不容易鉴别。近年来的研究发现, 随着社会老龄化的日益严重,发病率逐渐上升。抗角蛋白抗体(antikeratin antibody,AK