抗突变型瓜氨酸波形蛋白抗体及相关自身抗体在幼年特发性关节炎中的检测意义

Antibodies to mutated citrullinated vimentin and some associated autoantibodies in juvenile idiopathic arthritis

目的比较抗突变型瓜氨酸波形蛋白（MCV）抗体及相关自身抗体对幼年特发性关节炎（JIA）及分型的诊断价值；分析各抗体与JIA患儿炎性指标的关系。方法收集2008年1月-2014年10月住院的113例JIA患儿及56例非JIA患儿同期临床及实验室资料。采用酶联免疫吸附法检测抗MCV抗体、抗环瓜氨酸肽（CCP）抗体，乳胶凝集法检测类风湿因子，问接免疫荧光法检测抗角蛋白抗体、抗核周因子。结果（1）113例JIA组与非JIA组比较，抗MCV抗体（16．8％比2．2％）、抗CCP抗体（14．2％比2．2％）、类风湿因子（21．2％比6．5％）的阳性率差异有统计学意义（x^2=8．105、6．337、7．036，P〈0．05）；抗角蛋白抗体、抗核周因子的阳性率在两组问差异无统计学意义。抗MCV抗体、抗CCP抗体、类风湿因子、抗角蛋白抗体、抗核周因子对JIA诊断的ROC曲线下面积分别为0．579、0．561、0．578、0．539、0．505。（2）在JIA各亚型中，抗MCV抗体、抗CCP抗体的阳性率均高于类风湿因子、抗角蛋白抗体、抗核周因子。在类风湿因子阳性多关节型患儿中，抗MCV抗体、抗CCP抗体、抗角蛋白抗体、抗核周因子的阳性率均高于其他亚型，差异有统计学意义，余各亚型问差异无统计学意义。（3）抗MCV抗体及相关自身抗体与JIA患儿关节肿胀数、关节压痛数低度相关；与红细胞沉降率、C反应蛋白无相关。结论抗MCV抗体对JIA的诊断价值不高。在JIA各亚型中，抗MCV抗体阳性率均高于其他几种抗体。几种抗体均与关节肿胀数、关节压痛数低度相关。

Objective To compare the diagnostic value of antibodies to mutated citrullinated vimentin （MCV） and some associated autoantibodies in juvenile idiopathic arthritis and to further analyze the relation between antibodies and inflammatory markers. Method Antibodies to cyclic citrullinated peptides （CCP） and anti-MCV antibodies were deteeted by enzyme-linked immunosorbent assay （EHSA）, antiperinuclear factor （APF） and antikeratin antibody （AKA） by indirect immunofluoreseent assay, as well as rheumatoid factor （RF） by latex agglutination test in serum samples from 113 patients with JIA and 56 children without rheumatoid arthritis. Result （ 1 ） The positive rate of anti-MCV antibodies, anti-CCP antibodies, and RF was 16. 8% , 14. 2% , and 21.2% in the JIA. In the other group, the positive rate was 2. 2%, 2. 2%, and 6. 5% . There was a significant difference between the two groups （ X2 =8. 105, 6. 337, 7. 036, P 〈 0.05）. The positive rate of AKA and APF were not significantly difterent. The area under the ROC curve of anti-MCV antibodies, anti-CCP antibodies, RF, AKA, APF was O. 579, 0. 561, O. 578, O. 539, 0. 505. （2） The positive rate of anti-MCV antibodies and anti-CCP antibodies were higher than other antibodies. In the RF-positive polyarticular disease patients, they were higher than those in the other subtypes （ P 〈 O. 05 ）. Antibody levels were not significantly different （ P 〉 O. 05 ） fi＇om other subtypes. （ 3 ） The swollen joint counts and tender joint counts had a low correlation to anti-MCV antibodies, anti-CCP antibodies, RF, AKA and APF. No correlation was found between ESR, CRP and anti-MCV antibodies, anti-CCP antibodies, RF, AKA and APF. Conclusion The diagnostic value of anti-MCV antibodies is low for JIA. The positive rate of anti-MCV antibodies was higher than the other antibodies in the classification ofJIA. There was a low correlation between anti-MCV antibodies, anti-CCP antibodies, RF, AKA, APF and swollen joint counts, tender joint counts.