血清抗突变型瓜氨酸波形蛋白抗体在类风湿关节炎诊断中的价值

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

目的探讨抗突变型瓜氨酸波形蛋白(MCV)抗体在类风湿关节炎(RA)诊断中的价值。方法采用ELISA法测定68例RA患者(RA组)、62例关节疼痛及自身免疫性疾病患者(疾病对照组)、129例健康体检者(正常对照组)的抗MCV抗体、抗环瓜氨酸肽(CCP)抗体水平,计算抗MCV抗体与抗CCP抗体诊断RA的敏感性与特异性;速率散射比浊法检测CRP水平,记录压痛关节数(TJC)、肿胀关节数(SJC),并计算DAS28积分值。对抗MCV抗体与抗CCP抗体及DAS28积分(包括CRP、TJC、SJC三个变量)进行Spearman秩相关性分析。结果 RA组抗MCV抗体、抗CCP抗体、DAS28积分值显著高于疾病对照组及正常对照组;抗MCV抗体与抗CCP抗体诊断RA的敏感性分别为88.2%(60/68)、75.0%(51/68),P=0.026;特异性分别为97.3%(186/191)、95.8%(183/191),P=0.548。抗MCV与抗CCP抗体呈显著正相关(r=0.826,P<0.05);抗MCV与RA活动度指标DAS28积分及CRP、肿胀关节数间均有明显相关性。结论抗MCV抗体在RA诊断中较抗CCP抗体具有更高的敏感性和特异性,能为RA诊断提供良好的依据,且抗MCV抗体与RA病情活动度指标相关,高滴度的抗MCV可能在一定程度上提示RA的病情活动。

Objective To investigate the diagnostic significance of mutated citrulline vimentin （MCV）antibodies in patients with rheumatoid arthritis（RA）. Methods ELISA was used to detect anti-MCV and anti-cyclic citrullinated peptide （CCP）antibodies in 68 RA patients （RA group）, 62 patients with other connect tissue disease （ disease control group） and 129 healthy people（ normal control group）, the sensitivity and specificity of RA diagnosed by anti-MCV and an- ti-CCP antibodies were calculated; serum C-reactive protein （CRP） level was detected by rate nephelometry, the RA pa- tient＇s numbers of tenderness joints （TJC） and swelling joints （SJC） were counted, and the disease activity score-28 （DAS28） was calculated, as well. The relationship between the above two antibodies and DAS28 （also inculding CRP, TJC, SJC） was analyzed by Spearman＇s rank correlation analysis. Results The levels of serum anti-MCV antibody, anti- CCP antibody and DAS28 in RA group were significantly higher than those in the disease and the normal control groups ; the sensitivity of anti-MCV and anti-CCP antibodies for diagnosing RA were 88.2% （60/68）, 75.0% （51/68）, P = 0. 026 ; the specificity were 97.3% （ 186/191 ）, 95.8% （ 183/191 ）, P = 0.548. The serum anti-MCV antibody level was positively related to anti-CCP antibody （r = 0. 826, P 〈 0.05 ） ; anti-MCV antibody was also significantly related to the RA activity indexes such as DAS28, CRP and SJC. Conclusions Anti-MCV antibody has high sensitivity and specificity in the diag- nosis of RA, and it can be used as a good new diagnostic marker. There is a relationship between anti-MCV antibody and the activity of RA, high level of the antibody may predict activity of RA.