抗突变型瓜氨酸波形蛋白抗体和抗环瓜氨酸肽抗体对类风湿关节炎诊断价值的比较

目的：评价抗环瓜氨酸肽（CCP）抗体和抗突变型瓜氨酸波形蛋白抗体（MCV）对类风湿关节炎（RA）的诊断价值。方法：用酶联免疫吸附试验（ELISA）法分别测定RA患者47例、其他风湿病患者42例以及健康对照者30例血清中的抗CCP抗体和抗MCV抗体,并应用R0C曲线比较两者对RA的诊断价值。结果：RA组血清抗CCP抗体和抗MCV抗体水平（中位数）分别为120.0 U/mL和501.0 U/mL,分别与其他风湿病组（分别为12.5 U/mL和23.0 U/mL）和健康对照组（分别为12.0 U/mL和20.5 U/mL）比较,差异均有统计学意义（P〈0.01）。抗CCP抗体单项检测、抗MCV抗体单项检测、抗CCP抗体＋抗MCV抗体按序列实验联合检测和按平行试验联合检测诊断RA的敏感度分别为68.1%、72.3%、53.2%和83.0%,特异度分别为88.9%、87.5%、91.7%和84.7%,Youden指数分别为0.570、0.598、0.449和0.677。结论：抗MCV抗体同抗CCP抗体一样对RA有较高的诊断价值,以111.0 U/mL为界值点,对RA诊断的正确率更高,联合检测可弥补单项抗体检测造成的RA漏诊,按平行试验联合检测抗MCV抗体和抗CCP抗体对RA的诊断有很大的临床价值。

Study on the diagnostic value of anti-mutated citrullinated vimentin antibodies and anti-cyclic citrllinated peptide antibodies for rheumatoid arthrits

Objective：To assess the diagnostic value of anti-cyclic citrllinated peptide antibodies and anti-mutated citrullinated vimentin antibodies for rheumatoid arthrits（RA）.Methods：The level of seurm anti-CCP and anti-MCV in 47 patients with RA,42 patients with other rheumatic diseases and 30 normal controls were determined by ELISA.The diagnostic value of these two antibodies for RA were compared by receiver operating characteristic curve（ROC）.Results：The median levels of anti-CCP and anti-MCV were significantly higher in rheumatoid arthrits group（120.0 U/mL and 501.0 U/mL,respectively）than those of other rheumatic diseases group（12.5 U/mL and 12.0 U/mL,respectively）and healthy controls group（12.0 U/mL and 20.5 U/mL,respectively）（P0.01）.Sensitivity of detection for rheumatoid arthrits was 68.1%,72.3%,53.2% and 83.0% by isolated anti-CCP,by isolated anti-MCV,by combined anti-CCP and anti-MCV（in series） and by combined anti-CCP and anti-MCV（in paralle1）,respectively,and specificity of that was 88.9%,87.5%,91.7% and 84.7%,respectively,with Youden index of 0.570,0.598,0.449 and 0.677,respectively.Conclusion：The levels of anti-MCV have high value as same as anti-CCP in diagnosing RA.The set point of 111.0 U/mL is advantageous for the accurate diagnosis.The combination detection can decrease the amount of missed diagnosis caused by single test.Detection of both anti-MCV and anti-CCP in parallel showed a better value in clinical diagnosis for rheumatoid arthrits.