抗突变型瓜氨酸波形蛋白抗体在类风湿关节炎诊断中的意义

The diagnostic value of anti-mutated citrullinated vimentin antibody in patients with rheumatoid arthritis

目的了解抗突变型瓜氨酸波形蛋白(MCV)抗体在类风湿关节炎(RA)诊断中的意义,并比较抗MCV抗体与类风湿因子(RF)、抗核周因子(APF)、抗角蛋白抗体(AKA)、抗环瓜氨酸多肽(CCP)抗体以及某些临床指标的相关性。方法对166例研究对象,包括74例RA患者(其中早期18例,中晚期56例),50例非RA的风湿性疾病患者,42名健康对照,应用酶联免疫吸附试验(ELISA)检测血清中的抗MCV抗体,同时检测其他相关自身抗体,结合临床资料进行分析。结果74例RA中抗MCV抗体阳性58例,对RA诊断的敏感性为78％,特异性为95％,阳性预测值和阴性预测值分别为97％和71％。抗MCV抗体阳性的平均抗体浓度依次为(552±380)U/ml(RA组),(162±63)U/ml(非RA组),(63±46)U/ml (健康对照组)。RA组的平均抗体水平较高。抗MCV抗体和抗CCP抗体相关性最强(r=0．502,P=0．000),APF、AKA次之(r=0．369、0．408,P＜0．01)。抗MCV抗体与各项临床、实验室指标间的差异无统计学意义(P＞0．05)。结论抗MCV抗体在RA中具有较高的敏感性和特异性,且较APE、AKA与抗CCP抗体相关性强,可作为RA诊断的辅助指标。抗MCV抗体可能与病情活动度、功能状态无关。

Objective To investigate the significance of anti-mutated citrullinated vimentin （MCV） antibody in rheumatoid arthritis （RA） and study the correlation among anti-CCP, other antoantibodies and clinical manifestations of RA. Methods Anti-MCV antibody was detected by enzyme-linked immunosorbent assay （ELISA） in 166 serum samples including 74 from RA （18 cases with early RA and 56 cases with late RA）, 50 from non-RA rheumatic diseases and 42 cases of healthy blood donors. At the same time, other antuoantibodies were detected by different techniques, and their clinical meaning was investigated with the corresponding clinical data. Results Anti-MCV was found in 78% （58/74） of RA. The sensitivity and specificity of Anti-MCV in RA were 78% and 95%. The positive and negative predictive value was 97% and 71%. The average cut off concentration of Anti-MCV was （552±380）U/ml in RA, （162±63）U/ml in non-RA and （63±46）U/ml in healthy control. Anti-MCV was strongly correlated to anti-CCP （r=0.502, P=0.000）, then AKA （r=0.408） and APF （r=0.369）. No differences was found between Anti-MCV and other clinical/laboratory parameters （P〉0.05）. Conclusion Anti-MCV antibody may be a valuable diagnostic parameter for RA. Anti-MCV is more strongly correlated to anti-CCP than APE and AKA. It may not relate to disease activity and/or severity.