血清腺苷脱氨酶检测在几种自身免疫性疾病中的临床意义研究
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摘要
目的:探讨血清腺苷脱氨酶(ADA)检测在几种自身免疫性疾病诊断中的应用价值。方法:收集确诊的系统性红斑狼疮(127例)、类风湿性关节炎(103例)和重症肌无力患者(34例)的血清标本,以同时期体检的正常成人(149例)为对照,采用ADA偶联嘌呤核苷磷酸化酶(PNP)和黄嘌呤氧化酶(XOD)法检测血清中ADA活性。结果:系统性红斑狼疮、类风湿性关节炎、重症肌无力患者和正常体检者血清中的ADA活性均值分别为(12.91±5.82)U/L、(10.91±3.70)U/L、(9.21±3.57)U/L、(8.73±2.79)U/L。系统性红斑狼疮、类风湿性关节炎患者血清中ADA活性均显著高于正常体检者(P<0.05),而重症肌无力患者血清中ADA活性和正常体检者相比差别无统计学意义(P>0.05)。ROC结果显示将血清ADA活性>10U/L同时作为RA和SLE诊断的阳性值,ADA活性诊断SLE的AUC为0.748,敏感性为59.8%,特异性为83.2%。ADA活性诊断RA的敏感性为42.7%,特异性为83.2%。血清ADA活性为10 U/L作为诊断的参考值上限,其诊断SLE的效果优于ESR和hs-CRP,其诊断RA的效果低于ESR和hs-CRP。结论:系统性红斑狼疮、类风湿性关节炎患者血清ADA活性均有升高,在系统性红斑狼疮患者中升高更为明显,可作为系统性红斑狼疮潜在的辅助诊断标志物。
Objective: To investigate the diagnostic value of serum adenosine deaminase in several autoimmune diseases.Methods: Serum samples of patients with system lupus erythematosus(SLE, n=127), rheumatoid arthritis(RA, n=103) and myasthenia gravis(MG, n=34) were collected, the serum of normal adults as control. The serum ADA activity was detected by using ADA coupling purine nucleoside phosphorylase(PNP) and xanthine oxidase(XOD) method. Results: The average level of serum ADA activity in the SLE patients, RA patients, MG patients and normal subjects were(12.91 ±5.82) U/L,(10.91 ±3.70)U/L,(9.21 ±3.57)U/L,(8.73 ±2.79)U/L respectively. The ADA activity in serum of SLE, RA were significantly higher than that in controls(P<0.05), while the serum ADA activity of MG patients showed significant difference compared with controls(P>0.05). The receiver operating characteristic curve(ROC) showed that AUC was 0.748 when taking ADA activity >10U/L as the cutoff value, the sensitivity of ADA activity assay in the diagnosis of SLE was 59.8% and the specificity was 83.2%. The sensitivity of ADA activity in the diagnosis of RA was 42.7%, the specificity was 83.2%. The diagnosis effect of serum ADA activity in SLE was better than ESR and hs-CRP while lower than ESR and hs-CRP in RA. Conclusions: The average level of serum ADA activity in the SLE patients and RA patients were higher than in controls,and increased more obviously in SLE. The ADA activity could be a potential diagnostic serum marker in SLE.
Objective: To investigate the diagnostic value of serum adenosine deaminase in several autoimmune diseases.Methods: Serum samples of patients with system lupus erythematosus(SLE, n=127), rheumatoid arthritis(RA, n=103) and myasthenia gravis(MG, n=34) were collected, the serum of normal adults as control. The serum ADA activity was detected by using ADA coupling purine nucleoside phosphorylase(PNP) and xanthine oxidase(XOD) method. Results: The average level of serum ADA activity in the SLE patients, RA patients, MG patients and normal subjects were(12.91 ±5.82) U/L,(10.91 ±3.70)U/L,(9.21 ±3.57)U/L,(8.73 ±2.79)U/L respectively. The ADA activity in serum of SLE, RA were significantly higher than that in controls(P<0.05), while the serum ADA activity of MG patients showed significant difference compared with controls(P>0.05). The receiver operating characteristic curve(ROC) showed that AUC was 0.748 when taking ADA activity >10U/L as the cutoff value, the sensitivity of ADA activity assay in the diagnosis of SLE was 59.8% and the specificity was 83.2%. The sensitivity of ADA activity in the diagnosis of RA was 42.7%, the specificity was 83.2%. The diagnosis effect of serum ADA activity in SLE was better than ESR and hs-CRP while lower than ESR and hs-CRP in RA. Conclusions: The average level of serum ADA activity in the SLE patients and RA patients were higher than in controls,and increased more obviously in SLE. The ADA activity could be a potential diagnostic serum marker in SLE.
引文
[1]吴长有,杨安钢.临床免疫学[M].2011年11月第1版.北京:人民卫生出版社,2011:97-188Wu Chang-you,Yang An-gang.Clinical Immunology[M].First edition,November 2011.Beijing:People's Medical Publishing House,2011:97-188
[2]贾弘褆,冯作化.生物化学与分子生物学[M].北京:人民卫生出版社,2010:259-272Jia Hong-ti,Feng Zuo-hua.Biochemistry and Molecular biology[M].Beijing:People's Medical Publishing House,2010:259-272
[3]Booth C,Algar VE,Xu-Bayford J,et al.Non-infectious lung disease in patients with adenosine deaminase deficient severe combined immunodeficiency[J].J Clin Immunol,2012,32(3):449-453
[4]Grunebaum E,Cutz E,Roifman CM.Pulmonary alveolar proteinosis in patients with adenosine deaminase deficiency[J].J Allergy Clin Immunol,2012,129(6):1588-1593
[5]Manson D,Diamond L,Oudjhane K,et al.Characteristic scapular and rib changes on chest radiographs of children with ADA-deficiency SCIDS in the first year of life[J].Pediatr Radiol,2013,43(5):589-592
[6]Nikolajeva O,Worth A,Hague R,et al.Adenosine deaminase deficient severe combined immunodeficiency presenting as atypical haemolytic uraemic syndrome[J].J Clin Immunol,2015,35(4):366-372
[7]Saghiri R,Ghashghai N,Movaseghi S,et al.Serum adenosine deaminase activity in patients with systemic lupus erythematosus:a study based on ADA1 and ADA2 isoenzymes pattern[J].Rheumatology International,2012(No.6):1633-1638
[8]Turgay M,Durak I,Erten S,et al.Oxidative stress and antioxidant parameters in a Turkish group of patients with active and inactive systemic lupus erythematosus[J].APLAR Journal of Rheumatology,2007,(2):101-106
[9]Vinapamula K S.Serum Adenosine Deaminase as Inflammatory Marker in Rheumatoid Arthritis[J].J Clin Diagn Res,2015,9(9):C8-C10
[10]Zakeri Z,Izadi S,Niazi A,et al.Comparison of adenosine deaminase levels in serum and synovial fluid between patients with rheumatoid arthritis and osteoarthritis[J].Int J Clin Exp Med,2012,5(2):195-200
[11]Doudkani-Fard M,Ziaee V,Moradinejad M,et al.Sensitivity and specificity of adenosine deaminase in diagnosis of juvenile idiopathic arthritis[J].Med J Islam Repub Iran,2014:113
[12]Hochberg M C.Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus[J].Arthritis Rheum,1997,40(9):1725
[13]Aletaha D,Neogi T,Silman A J,et al.2010 Rheumatoid arthritis classification criteria:an American College of Rheumatology/European League Against Rheumatism collaborative initiative[J].Ann Rheum Dis,2010,69(9):1580-1588
[14]中华医学会神经病学分会神经免疫学组.中国重症肌无力诊断和治疗指南2015[J].中华神经科杂志,2015,(11):934-940Neuroimmunolog Branch of Chinese Medical Association of Neurology.Guidelines for the diagnosis and treatment of myasthenia gravis in China 2015[J].Chinese Journal of Neurology,2015,(11):934-940
[15]胡志坚,荀春华,韩峰,等.26例成人Still's患者腺苷脱氨酶分析[J].第三军医大学学报,2012,34(14):1473-1475Hu Zhi-jian,Xun Chun-hua,Han Feng,et al.Analysis of 26 cases of Adult Still's Diseases with adenosine deaminase[J].Journal of Third Military Medical University,2012,34(14):1473-1475
[16]Osmani A M,Sayeed D,Ali G M.Study of serum adenosine deaminase and alkaline phosphatase in Rheumatoid Arthritis[J].Journal of Evolution of Medical and Dental Sciences,2015,4(03):312-317
[17]Gautam N,Archana J,Kumar R,et al.Serum total adenosine deaminase activity in Nepalese patients with Rheumatoid Arthritis[J].Asian Journal of Medical Sciences,2013,(2):30-35
[18]Salesi M,Ghazvini RA,Farajzadegan Z,et al.Serum adenosine deaminase in patients with rheumatoid arthritis treated with methotrexate[J].J Res Pharm Pract,2012,1(2):72-76
[19]Demir G,Borman P,Ayhan F,et al.Serum Adenosine Deaminase Level is High But Not Related with Disease Activity Parameters in Patients with Rheumatoid Arthritis[J].Open Rheumatol J,2014,8:24-28
[20]Antonioli L,Colucci R,La Motta C,et al.Adenosine deaminase in the modulation of immune system and its potential as a novel target for treatment of inflammatory disorders[J].Curr Drug Targets,2012,13(6):842-862
[2]贾弘褆,冯作化.生物化学与分子生物学[M].北京:人民卫生出版社,2010:259-272Jia Hong-ti,Feng Zuo-hua.Biochemistry and Molecular biology[M].Beijing:People's Medical Publishing House,2010:259-272
[3]Booth C,Algar VE,Xu-Bayford J,et al.Non-infectious lung disease in patients with adenosine deaminase deficient severe combined immunodeficiency[J].J Clin Immunol,2012,32(3):449-453
[4]Grunebaum E,Cutz E,Roifman CM.Pulmonary alveolar proteinosis in patients with adenosine deaminase deficiency[J].J Allergy Clin Immunol,2012,129(6):1588-1593
[5]Manson D,Diamond L,Oudjhane K,et al.Characteristic scapular and rib changes on chest radiographs of children with ADA-deficiency SCIDS in the first year of life[J].Pediatr Radiol,2013,43(5):589-592
[6]Nikolajeva O,Worth A,Hague R,et al.Adenosine deaminase deficient severe combined immunodeficiency presenting as atypical haemolytic uraemic syndrome[J].J Clin Immunol,2015,35(4):366-372
[7]Saghiri R,Ghashghai N,Movaseghi S,et al.Serum adenosine deaminase activity in patients with systemic lupus erythematosus:a study based on ADA1 and ADA2 isoenzymes pattern[J].Rheumatology International,2012(No.6):1633-1638
[8]Turgay M,Durak I,Erten S,et al.Oxidative stress and antioxidant parameters in a Turkish group of patients with active and inactive systemic lupus erythematosus[J].APLAR Journal of Rheumatology,2007,(2):101-106
[9]Vinapamula K S.Serum Adenosine Deaminase as Inflammatory Marker in Rheumatoid Arthritis[J].J Clin Diagn Res,2015,9(9):C8-C10
[10]Zakeri Z,Izadi S,Niazi A,et al.Comparison of adenosine deaminase levels in serum and synovial fluid between patients with rheumatoid arthritis and osteoarthritis[J].Int J Clin Exp Med,2012,5(2):195-200
[11]Doudkani-Fard M,Ziaee V,Moradinejad M,et al.Sensitivity and specificity of adenosine deaminase in diagnosis of juvenile idiopathic arthritis[J].Med J Islam Repub Iran,2014:113
[12]Hochberg M C.Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus[J].Arthritis Rheum,1997,40(9):1725
[13]Aletaha D,Neogi T,Silman A J,et al.2010 Rheumatoid arthritis classification criteria:an American College of Rheumatology/European League Against Rheumatism collaborative initiative[J].Ann Rheum Dis,2010,69(9):1580-1588
[14]中华医学会神经病学分会神经免疫学组.中国重症肌无力诊断和治疗指南2015[J].中华神经科杂志,2015,(11):934-940Neuroimmunolog Branch of Chinese Medical Association of Neurology.Guidelines for the diagnosis and treatment of myasthenia gravis in China 2015[J].Chinese Journal of Neurology,2015,(11):934-940
[15]胡志坚,荀春华,韩峰,等.26例成人Still's患者腺苷脱氨酶分析[J].第三军医大学学报,2012,34(14):1473-1475Hu Zhi-jian,Xun Chun-hua,Han Feng,et al.Analysis of 26 cases of Adult Still's Diseases with adenosine deaminase[J].Journal of Third Military Medical University,2012,34(14):1473-1475
[16]Osmani A M,Sayeed D,Ali G M.Study of serum adenosine deaminase and alkaline phosphatase in Rheumatoid Arthritis[J].Journal of Evolution of Medical and Dental Sciences,2015,4(03):312-317
[17]Gautam N,Archana J,Kumar R,et al.Serum total adenosine deaminase activity in Nepalese patients with Rheumatoid Arthritis[J].Asian Journal of Medical Sciences,2013,(2):30-35
[18]Salesi M,Ghazvini RA,Farajzadegan Z,et al.Serum adenosine deaminase in patients with rheumatoid arthritis treated with methotrexate[J].J Res Pharm Pract,2012,1(2):72-76
[19]Demir G,Borman P,Ayhan F,et al.Serum Adenosine Deaminase Level is High But Not Related with Disease Activity Parameters in Patients with Rheumatoid Arthritis[J].Open Rheumatol J,2014,8:24-28
[20]Antonioli L,Colucci R,La Motta C,et al.Adenosine deaminase in the modulation of immune system and its potential as a novel target for treatment of inflammatory disorders[J].Curr Drug Targets,2012,13(6):842-862