人血清抗MCV-Ab与类风湿关节炎合并间质性肺病的关系

Correlation between the levels of human serum anti-mutant citrulline vimentin antibody and rheumatoid arthritis complicated by interstitial lung disease

目的研究血清抗突变型瓜氨酸波形蛋白抗体(MCV-Ab)水平与类风湿关节炎(rheumatoid arthritis,RA)患者合并间质性肺病的关系。方法选取147例RA患者,根据有无合并间质性肺病(ILD)分为RA-ILD组(n=93),RA组(未合并ILD)(n=54),测定并分析2组患者抗MCV-Ab、抗环瓜氨酸肽抗体(CCP-Ab)和类风湿因子(RF)指标。RA-ILD组行肺功能(DLCo)及肺部高分辨CT(HRCT)检查,并将血清抗MCV-Ab水平和HRCT评分及DLCo进行相关分析。测定RA-ILD组接受环磷酰胺(CTX)和糖皮质激素治疗的患者(43例)治疗前、治疗后3月和治疗后6月抗MCV-Ab水平。结果 RA-ILD组抗MCV-Ab、抗CCP-Ab和RF水平高于RA组(P<0.05),RA-ILD组抗MCV-Ab高水平(>500U/ml)患者所占的百分比明显高于单纯RA组(P<0.05)。抗体联合检测特异性更高。RAILD组血清抗MCV-Ab水平和HRCT评分呈正相关(r=0.43,P<0.001),与DLCo呈负相关相关(r=-0.23,P<0.001)。经CTX治疗后缓解的患者血清抗MCV-Ab水平逐渐下降(F=6.03,P<0.01),未缓解者下降不明显(F=1.04,P=0.49)。结论高水平的抗MCV-Ab可能与RA患者合并间质性肺病的发生与发展密切相关,抗体联合检测更有利于RA-ILD诊治,抗MCV-Ab水平可作为RA-ILD患者病情评估的指标,CTX治疗前后血清抗MCV-Ab水平的变化可以预测RA-ILD患者治疗效果。

Objective To investigate the correlation between the levels of human serum anti-mutant citrulline vimentin antibody(MCV-Ab)and rheumatoid arthritis(RA)complicated by interstitial lung disease(ILD).Methods A total of 147 patients with RA were enrolled in the study,who were divided into RA+ILD group(n=93)and RA group(n=54)according to whether they had ILD or not.The anti MCV-Ab,anti cyclic citrulline peptide antibody(CCP-Ab)and rheumatoid factor(RF)were detected in both groups.The patients in RA+ILD group received examination of carbon monoxide diffusing capacity(DLCo)and lung high resolution computer test(HRCT).Moreover the levels MCV-Ab of patients in RA+ILD group who received treatment with cyclophosphamide(CTX)and glucocorticoid before treatment and at 3m6m after treatment were detected.Moreover the correlation between the serum levels of MCV-Ab and HRCT score as well as DLCo was analyzed.Results The serum levels of anti MCV-Ab,anti CCP-Ab and RF in RA+ILD group were significantly higher than those in RA group(P<0.05),and the proportion of patients with high levels of MCV-Ab(>500U/ml)in RA+ILD group was significantly higher than that in RA group(P<0.05).The specificity of combination detection was higher.Moreover the serum levels of anti MCV-Ab in RA+ILD group were positively correlated with pulmonary HRCT scores(r=0.43,P<0.01),however,which were negatively correlated with DLCo(r=-0.23,P<0.01).The serum levels of anti MCV-Ab were decreased gradually in the patients who got remission of disease condition after CTX treatment(F=6.03,P<0.01),however,the serum levels of anti MCV-Ab were not significantly decreased in the patients without remission of disease condition after CTX treatment(F=1.04,P>0.05).Conclusion High levels of anti MCV-Ab may be closely related to the occurrence and development of Racomplicated by ILD.The combination detection of antibodies is more favorable for diagnosis and treatment of RA+ILD,and anti MCV-Ab levels can be regarded as the indexes to evaluate the disease condition of patients with RA+ILD,moreover,the changes of serum levels of anti MCV-Ab before and after CTX treatment can predict the treatment effects on RA+ILD.