抗突变型瓜氨酸波形蛋白抗体在类风湿关节炎诊断中的研究

目的:探讨抗突变型瓜氨酸波形蛋白抗体(anti-MCV)对类风湿性关节炎(RA)早期诊断和预后判断的价值。方法:采用酶联免疫吸附测定法(ELISA)定量检测52例RA患者、48例其他结缔组织病患者、30例正常对照者血清中anti-MCV水平,同时测定抗环瓜氨酸肽抗体(anti-CCP)浓度、IgM型类风湿因子(IgM-RF)浓度,分析RA组患者肿胀关节数、压痛关节数、血清C反应蛋白(CRP)及疾病活动程度(DAS28-3)积分;对于病史短于1年的12例RA患者拍摄双手、双足X线片,计算骨侵蚀(Sharp)积分。结果:anti-MCV≥60U/mL判为阳性标准,anti-MCV抗体检测对RA诊断的敏感性为78.85%,特异性为93.59%。anti-MCV对RA诊断的敏感性低于IgM-RF,特异性明显高于IgM-RF。与anti-CCP相比较,anti-MCV的敏感性和特异性均高于前者。患者anti-MCV水平与DAS28-3积分呈正相关;其中12例早期患者anti-MCV水平与Sharp积分呈正相关。结论:anti-MCV抗体可以作为RA的临床诊断指标,用于RA的早期诊断、鉴别诊断、判断预后。高滴度anti-MCV提示RA病情活动,预后不良。

The Diagnostic Value of the Antibodies against Mutated Citrullinated Vimentin in Patients with Rheumatoid Arthritis

Objective:To investigate the diagnostic value of a newly developed enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies against mutate citrullinated vimentin (anti-MCV) in patients with rheumatoid arthritis (RA). Methods: Using the serum ELISA testing to detect anti-MCV antibodies in a group of 52 RA patients,the control group included 48 patients with other connect tissue diseases and 30 healthy people were as normal control. The anti-citrullinated peptide antibaby (anti-CCP) ,IgM-RF and serum C-reactive protein(CRP) were detected as well. The numbers of swelling joints and the tenderness joints were calculated. Finally the disease activity score-28 (DAS28-3) scores were calculated. The standardized radiographs of the hands and feet in patients with recent onset of RA (<1 year; n = 12) were considered the Sharp scores. Statistical analysis was performed using the SPSS program,version 13.0. Results: Using the cutoff value of 60.0 U/mL for the anti-MCV ELISA,the sensitivity was 78.85% and the specificity was 93.59% for RA diagnosis. The anti-MCV ELISA demonstrated lower sensitivity and higher specificity compared with that of the IgM-RF test. With comparable specificity and sensitivity,the anti-MCV assay showed a substantially better than that of anti-CCP. A good correlation of the anti-MCV with the disease activity score was documented and there was also a closely connection between anti-MCV and Sharp scores in the recent RA onset group. Conclusion: Anti-MCV showed a higher diagnostic value of RA,represented an important parameter for monitoring RA,especially in early cases with high titre.