抗突变型瓜氨酸波形蛋白抗体抗环瓜氨酸肽抗体对类风湿关节炎与幼年特发性关节炎患者诊断价值的比较

Comparison of anti-mutated citrullinated vimentin antibodies and anti-cyclic citrnilinated peptide antibodies in the diagnosis of juvenile idiopathic arthritis and rheumatoid arthritis

目的比较分析RA和幼年特发性关节炎（JIA）患者血清中抗突变型瓜氨酸波形蛋白（MCV）抗体、抗CCP抗体阳性率，探讨抗MCV抗体及抗CCP抗体对2种疾病的诊断价值。方法收集632例RA患者、113例JIA患儿、102例其他成人风湿病患者及56例非JIA患儿临床及实验室资料。采用ELISA法检测抗MCV抗体、抗CCP抗体。采用，检验、多重比较进行统计学分析。结果①在RA患者中，抗MCV抗体的敏感度、特异度、受试者工作特征曲线（ROC）曲线下面积分别为90．2％、91．2％、0．919；抗CCP抗体的敏感度、特异度、ROC曲线下面积分别为92．6％、93．1％、0．934。在JIA患儿中，2种抗体的特异度均为98．2％，敏感度均较低；抗MCV抗体ROC曲线下面积为0．579，抗CCP抗体ROC曲线下面积为0．561。②抗MCV抗体在RA患者中的阳性率为90．2％，高于JIA患儿（16．8％）（P〈0．01）；抗CCP抗体在RA患者中的阳性率为92．2％，高于JIA患儿（14．2％）（P〈0．01）。③JIA患儿中，抗MCV抗体在RF阴性多关节型阳性率为11．8％，RF阳性多关节型为69．2％，全身型为14．3％，少关节型为17．4％，附着点炎相关型为3．6％，未分类为0％。抗CCP抗体在RF阴性多关节型阳性率为11．8％，RF阳性多关节型为61．5％，全身型为14．3％，少关节型为13．0％，附着点炎相关型为0，未分类为0。在抗MCV抗体中，RA患者与RF阴性多关节型JIA患儿间（x^2=160．2），与RF阳性多关节型间（x^2=4.02），与全身型间（x^2=34．4），与少关节型间（x^2=102．0），与附着点相关型间（x^2=r165．1），与未分类间（x^2=57．0）比较差异均有统计学意义（P〈0．05）。在抗CCP抗体中，RA患者与RF阴性多关节型JIA患儿间（x^2=192．3），与RF阳性多关节型间（x^2=11．9），与全身型间（x^2=44．0），与少关节型间（x^2=139．4），与附着点相关型间（x^2=212．5），与未分类间（x^2=71．9）比较差异均有统计学意义（P〈0．05）。结论抗MCV抗体、抗CCP抗体对RA的诊断价值较高，对BA具有一定的诊断价值。抗MCV抗体、抗CCP抗体在各型JIA患儿中阳性率均低于RA患者。

Objective To compare the positive rate of anti-mutant citrulhne vimentin （MCV） antibody and anti-cyclic citrullinated peptide （CCP） antibody in serum of patients with rheumatoid arthritis （RA） and juvenile idiopathic arthritis （JIA）. To investigate the diagnostic value and significance of anti-MCV and anti- CCP antibody in these two diseases. Methods Anti-CCP and anti-MCV antibodies were detected by enzyme- linked immunosorbent assay （ELISA）. The serum samples were from 113 patients with JIA, 632 patients with RA, 102 adult without RA and 56 children without RA. Chi-square test and multiple comparisons were used for statistical analysis. Results （1） In RA patients, the sensitivity, specificity and area under the receiver operating characteristic curve （ROC curve） of anti-MCV antibody was 90.2%, 91.2%, 0.919; the sensitivity, specificity and area under the ROC curve of anti-CCP antibody was 92.6%, 93.1% and 0.934. In J!A, the specificity of antibodies was 98.2%, the sensitivity was low. Area under the ROC curve of anti-MCV antibody was 0.579. Ai＇ea under the ROC curve of anti-CCP antibody was 0.561. （2） The positive rate of anti-MCV antibody in RA was 90.2%, which was higher than that of JIA （16.8%） （P〈0.01）. The positive rate of anti-CCP antibody in RA was 92.2%, which was higher than that of JIA （14.2%） （P〈0.01）. The positive rates of anti- MCV antibody in JIA with RF-negative polyarthrosis, RF-positive polyarthrosis, systemic type, oligo-joint type, attachment points, unclassified was 11.8%, 69.2%, 14.3%, 17.4%, 3.6%, 0. The positive rate of anti-CCP was 11.8%, 61.5%, 14.3%, 13.0%, 0 and 0 prespectively. For anti-MCV antibody, the chi-square values in patients with RA between RF-negative polyarthrosis, RF-positive olyarthrosis, systemic type, oligo-joint type, attachment points, unclassified arthritis were 160.2, 4.02, 34.4, 102.0, 165.1 and 57.0 respectively. There were significant differences between RA and all types of JIA （P〈0.05）. The positive rate of anti-CCP antibody in patients with RA between RF-negative polyarthrosis, RF-positive polyarthrosis, systemic type, iligo-joint type, attachment points, unclassified arthritis were 192.3, 11.9, 44.0, 139.4, 212.5 and 71.9. There were significant differences between RA and all types of JIA （P〈0.05）. Conclusion The diagnostic value of anti-MCV and anti-CCP antibodies is high in RA. Anti-MCV and anti-CCP antibody have certain diagnostic value of JIA. The positive rates of anti-MCV and anti-CCP antibody in the types in JIA are lower than those of RA patients.