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

Value of anti-mutated citrullinated vimentin antibody to the diagnosis of rheumatoid arthritis

目的探讨抗突变型瓜氨酸波形蛋白(mutated citrullinated vimentin,MCV)抗体对类风湿关节炎(rheumatoid arthritis,RA)的临床诊断价值。方法 791例RA患者为RA组,1 369例非RA自身免疫病患者为非RA组,100例体检健康者为对照组,3组采用ELISA法检测血清抗MCV抗体和抗环瓜氨酸多肽(cyclic citrullinated peptide,CCP)抗体水平,分析抗MCV和抗CCP抗体的相关性及其诊断RA的敏感性和特异性。结果 RA组血清抗MCV抗体[(95.1±16.6)RU/mL]和抗CCP抗体水平[(89.3±12.9)RU/mL]明显高于非RA组[(8.8±4.3)、(17.5±5.8)RU/mL](P<0.05)和对照组[(6.8±2.9)、(9.1±3.5)RU/mL](P<0.05),非RA组与对照组比较差异无统计学意义(P>0.05);ROC曲线分析结果显示,抗MCV抗体及抗CCP抗体诊断RA的AUC均为0.95;抗MCV抗体诊断RA的敏感性为82.1%,特异性为97.9%,阳性预测值为95.4%,阴性预测值为91.1%;抗CCP抗体诊断RA的敏感性为78.1%,特异性为98.1%,阳性预测值为94.5%,阴性预测值为90.3%;抗MCV抗体与抗CCP抗体呈正相关(r=0.726,P=0.008)。结论抗MCV抗体与抗CCP抗体诊断RA均有较好的敏感性和特异性,抗MCV抗体敏感性高于抗CCP抗体,可作为诊断RA的有效指标。

Objective To investigate the clinical value of anti-mutated citrulline vimentin （anti-MCV） antibody to the diagnosis of rheumatoid arthritis （RA）. Methods The serum levels of anti MCV antibody and anti-cyclic citrullinated peptide （anti-CCP） antibody were detected by ELISA and were compared among 791 RA patients （RA group）, 1 369 non-RA patients （non-RA group） and 100 healthy volunteers （control group）. The correlation between anti-MCV antibody and anti CCP antibody and their diagnostic sensitivity and specificity for RA were analyzed. Results The serum levels of anti-MCV antibody and anti-CCP antibody were significantly higher in RA group （（95.1 ±16.6）, （89.3 ± 12.9） RU/mL） than those in non-RA group （（8.8±4.3）, （17.5±5.8） RU/mL） and control group （（6.8±2.9）, （9.1±3.5） RU/mL） （P〈0.05）, and there were no significant differences between non-RA group and control group （P〉0.01）. ROC showed AUC of anti-MCV antibody for RA was 0. 95, the sensitivity was 82. 1%, the specificity was 97. 9 %, positive predictive value was 95.4%, and negative predictive value was 91.1%. AUC of anti-CCP antibody for RA was 0.95, the sensitivity was 78. 1%, the specificity was 98. 1%, positive predictive value was 94. 5%, and negative predictive value was 90. 3%. Anti-MCV antibody was positively correlated with anti CCP antibody （r= 0. 726, P= 0. 008）. Conclusion Both anti-MCV antibody and anti CCP antibody have good sensitivity and specificity for diagnosing RA. The sensitivity of anti-MCV antibody is much higher than that of anti-CCP antibody, which could be used as an effective index for the diagnosis of RA.