抗突变型瓜氨酸波形蛋白检测在类风湿关节炎中的意义

Detection of the antibodies of anti-mutated citrullinated vimentin in diagnosis of rheumatoid arthritis

目的:评价抗突变型瓜氨酸波形蛋白(抗MCV)在类风湿关节炎(RA)诊断中的价值。方法:检测225例RA患者、77例其他关节炎患者以及80例正常对照血清中抗MCV、抗CCP和RF-IgM的水平,比较抗MCV、RF-IgM、抗CCP及抗MCV和抗CCP联合检测在类风湿关节炎的诊断中的意义。结果:①抗MCV、RF-IgM、抗CCP敏感性和特异性分别为74.67%、91.71%;77.78%、91.71%;65.33%、94.27%,抗MCV与抗CCP联合检测可明显提高诊断特异性,对RA诊断的敏感性和特异性分别为60.89%、99.36%;②抗MCV与抗CCP检测对RF阴性RA病例的诊断有一定价值(30%,26%);③抗MCV、抗CCP与RF-IgM之间均显著相关(P<0.01);④抗MCV与年龄、病程、功能分级、压痛关节数、ESR、CRP、X线分期及晨僵持续时间存在相关(P<0.01或P<0.05),而与性别、双手平均握力和肿胀关节数无关(P>0.05)。结论:抗MCV对RA有较高的诊断价值,抗CCP和抗MCV联合检测对RA有高度特异性,抗MCV能一定程度反映RA的临床病情,可作为RA的血清学指标。

Objective：To analyze diagnostic value of anti-mutated citrullinated vimentin （anti-MCV） antibody for rheumatoid arthritis （RA）. Methods： The anti-MCV antibodies were determined in 225 patients with RA,77 non-RA patients and 80 normal volunteers. The diagnostic value of anti-MCV and antibody combination of anti-MCV with anti-cyclic citrullinated peptide antibodies （anti-CCP） were assessed and compared with that of anti-CCP and Rheumatoid factors （RF）. Results： The sensitivities of anti-MCV, RF-IgM and anti-CCP in the 225 patients were of 74.67 %, 91.71% and 77.78 % ; With specifities of 91.71%, 65.33 % and 94.27 %. The sensitivity and specificity of the combination of anti-MCV with anti-CCP was 60.89% and 99.36%. Anti-MCV and anti-CCP were valuable criteria for diagnosis of RA where RF was negative （30% and 26% respectively）. Anti-MCV presented a significantly positive correlation with anti-CCP and RF（ P 〈 O. 01 ）. Anti-MCV presented positive correlation with ages, course, ranks of joint function, number of tender joints, ESR, CRP, stages of radiology and duration of morning stiffness（P 〈 0.01 or P 〈 0.05）. Anti-MCV presented no correlation with sex, gripping power and number of swollen joints（ P 〉 0.05）. Conclusion： Anti-MCV is a valuable index for the diagnosis of RA.