抗突变型瓜氨酸波形蛋白抗体在类风湿关节炎诊断中的应用

Application of anti-mutated citrullinated vimentin antibody 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)诊断中的应用。方法前瞻性纳入RA患者,分别采用散射比浊法检测血清RF、ELISA检测抗环瓜氨酸肽(CCP)抗体和抗MCV抗体。若抗体水平升高但不超过3倍正常上限定义为低滴度阳性,若超过3倍正常上限定义为高滴度阳性。结果共纳入148例RA患者,RF、抗CCP抗体和抗MCV抗体的阳性率分别为72.3%、74.3%和77.7%,高滴度阳性率分别为52.7%、54.7%和65.5%,其中抗MCV抗体高滴度阳性率明显高于RF和抗CCP抗体(均P<0.05)。41例RF阴性的RA患者中,抗MCV抗体阳性率为46.3%。24例RF和抗CCP抗体均阴性的RA患者中,抗MCV抗体阳性率为33.3%,其中低滴度阳性的患者占8.3%,高滴度阳性者占25.0%。22例RF或抗CCP抗体至少1个低滴度阳性且均无高滴度阳性的患者中,抗MCV抗体低滴度阳性和高滴度阳性的患者分别占9.1%和59.1%。结论抗MCV抗体对诊断RA尤其是血清学阴性的患者有一定的补充价值。

Objective To investigate the application of anti-mutated citrullinated vimentin(MCV)antibody in the diagnosis of rheumatoid arthritis(RA).Methods RA patients were recruited in this study.Serum rheumatoid factor(RF)was detected by immunoturbidimetry,anti-cyclic citrullinated peptide(CCP)antibody and anti-MCV antibody were detected by enzyme linked immunosorbent assay.Low-titer positivity refers to antibody titer higher than the upper limit of normal range(ULN)but≤3 times of ULN,whereas hightiter positivity refers to antibody titer>3 times of ULN.Results Among 148 RA patients,the positive rates of RF,anti-CCP and anti-MCV antibodies were 72.3%,74.3%,and 77.7%,respectively.The positive rate of high-titer anti-MCV antibody was 65.5%,significantly higher than 52.7%and 54.7%of RF and anti-CCP antibody(both P<0.05).In RF-negative RA patients(n=41),the positive rate of anti-MCV antibody was 46.3%.In seronegative RA patients with both negative RF and anti-CCP antibody(n=24),the positive rate of anti-MCV antibody was 33.3%.Among them,8.3%patients had low-titer positivity and 25.0%had high-titer positivity.In RA patients with either low-titer RF or/and low-titer anti-CCP antibody without high-titer RF and anti-CCP antibody(n=22),the positive rates of low-titer anti-MCV antibody and high-titer anti-MCV antibody were 9.1%and 59.1%,respectively.Conclusion Anti-MCV antibody has complementary diagnostic value in RA,especially for seronegative RA patients with both negative RF and anti-CCP antibody.