抗突变型瓜氨酸波形蛋白抗体对类风湿关节炎的诊断价值

Diagnostic value of antibodies against mutated citrullinated vimentin for rheumatoid arthritis

目的:探讨抗突变型瓜氨酸波形蛋白(MCV)抗体对类风湿关节炎(RA)的诊断价值。方法:用酶联免疫吸附试验测定117例RA患者(RA组)和42例正常对照的血清抗MCV和抗环瓜氨酸多肽(CCP2)抗体,用速率散射免疫比浊法同步检测类风湿因子IgM(RF-IgM),利用受试者工作特征(ROC)曲线分析抗MCV抗体对RA的诊断价值。结果:抗MCV和抗CCP2抗体的诊断界值分别为21U/mL、12U/mL时,2者对RA诊断的灵敏度分别为75.6%和66.7%,特异性分别为92.5%和98.1%,2者联合的灵敏度和特异性分别为63.2%和98.7%;抗MCV抗体的ROC曲线下面积(AZ)为0.853(95%CI0.801～0.906),抗CCP2抗体的AZ为0.910(95%CI0.873～0.946),2者差异无统计学意义(Z=0.890,P=0.230)。2者联合的AZ为0.923(95%CI0.831～0.957),与抗MCV和抗CCP2抗体单独测定的AZ比较,差异亦无统计学意义(Z=2.190,P=0.080;Z=1.670,P=0.120)。结论:抗MCV抗体在诊断RA时与抗CCP2抗体效果相当,2者联合检测并无明显优势。

Aim：To test the diagnostic value of antibodies against mutated citrullinated vimentin（anti-MCV） for rheumatoid arthritis（RA）.Methods：A total of 117 patients with RA and 42 normal control were subjected to test the presence of anti-MCV and antibodies against cyclic citrullinated peptides（anti-CCP2） using ELISA method,and rheumatoid factor IgM（RF-IgM）,simultaneously by immune rate nephelometry.Receiver operating characteristics（ROC） curve was used to analyze the diagnostic value.Results：When categorised with a cutoff value of 21 U/mL for anti-MCV and 12 U/mL for anti-CCP2,sensitivity and specificity of anti-MCV were 75.6% and 92.5%,those of anti-CCP2 were 66.7% and 98.1%,and those of combination of anti-MCV and anti-CCP2 were 63.2% and 98.7%.The calculated area under the ROC curve（AZ） of anti-MCV was 0.853（95% CI 0.801 ～ 0.906）,did not differ from 0.910（95% CI 0.873 ～ 0.946） of anti-CCP2（Z = 0.890,P =0.230）.AZ of combination of anti-MCV and anti-CCP2 was 0.923（95% CI 0.831 ～ 0.957）,did not differ from those of single anti-MCV or anti-CCP2（Z = 2.190,P = 0.080;Z = 1.670,P = 0.120）.Conclusion：The serum anti-MCV performs well in the diagnosis of RA compared with anti-CCP2,but the combination of them has no significant advantage.