抗CCP抗体及抗MCV抗体在RA炎诊断中的作用
徐宁
摘要：在类风湿关节炎的患者中许多自身免疫性抗体针对瓜氨酸化蛋白抗原表位产生的，其中之一是抗瓜氨酸化波形蛋白抗体，我们用一种新改良的ELISA方法检测抗波形蛋白抗体，并与抗环瓜氨酸抗体的ELISA检测在类风湿关节炎诊断中作用进行了对比，35例类风湿患者纳入了这一研究（平均年龄42.6 +/- 10.87岁，平均病程9.37 +/- 3.98年），25例强直性脊柱炎患者纳入研究（平均年龄35.88 +/- 6.64岁，平均病程10.25 +/- 4.61年），19例健康人群被作为对照组纳入研究（平均年龄40.26 +/- 5.11岁）。抗环瓜氨酸多肽抗体及抗瓜氨酸化波形蛋白抗体均用ELISA方法进行检测。在所有类风湿关节炎患者中，抗环瓜氨酸多肽抗体69.07 +/- 90.43 U/ml及抗波形蛋白抗体665.77 +/- 1040.19 U/ml，强直性脊柱炎患者中，抗环瓜氨酸多肽抗体10.7 +/- 5.22 U/ml及抗波形蛋白抗体40.54 +/- 20.15 U/ml，健康人群中，抗环瓜氨酸多肽抗体11.11 +/- 7.65 U/ml,及抗波形蛋白抗体23.12 +/- 12.04 U/ml，在活动性类风湿关节炎患者中，抗环瓜氨酸多肽抗体100.54 +/- 98.07 U/ml及抗波形蛋白抗体998.74 +/- 1154.93 U/ml，在非活动性类风湿关节炎患者中，抗环瓜氨酸多肽抗体100.54 +/- 98.07 U/ml及抗波形蛋白抗体27.59 +/- 23.10 U/ml。根据这些结果：类风湿关节炎患者抗环瓜氨酸多肽抗体及抗波形蛋白抗体的平均血清水平高于强直性脊柱炎患者和健康对照者，(p=0.002, p=0.001, p=0.002, p=0.001)。在活动性类风湿关节炎患者中抗环瓜氨酸多肽抗体及抗波形蛋白抗体平均血清水平高于非活动性类风湿关节炎患者(p=0.001 and p=0.001)。在非活动性类风湿关节炎患者抗环瓜氨酸多肽抗体及抗波形蛋白抗体平均血清水平与强直性脊柱炎患者和健康对照者类似（p=0.484, p=0.308, p=0.09 and p=0.222）。抗波形蛋白抗体平均血清水平与以下各项相关：DAS 28评分 (r=0.531, p=0.001), VAS 评分 (r=0.332, p=0.01), ESR (r=0.458, p=0.001)，血清CRP 水平 (r=0.568, p=0.01), 血清 RF水平 (r=0.529, p=0.001),肿胀关节数 (r=0.525, p=0.001)及 触痛关节数 (r=0.638, p=0.001)。总之，检测血清中抗波形蛋白抗体水平对于类风湿关节炎的诊断很有用处。并且结合抗波形蛋白抗体水平及血清 RF水平的检测比单独应用抗环瓜氨酸多肽抗体血清水平和血清 RF水平更有助于对于类风湿关节炎患者的预后分析。
附原文：Abstract Several autoantibodies found in RA are directed to epitopes in citrullinated proteins. One of them is anti modified citrullinated vimentin (Anti-MCV). We tested the value a newly developed ELISA for the detection of antibodies against a genetically modified citrullinated vimentin (anti-MCV) in comparison with an anti-CCP based ELISA system for the diagnosis of RA. Thirty-five patients with RA (mean age; 42.6 +/- 10.87 years, mean disease duration; 9.37 +/- 3.98 years) were enrolled in this study. Twenty -five ankylosing spondylitis (mean age; 35.88 +/- 6.64 years, mean disease duration; 10.25 +/- 4.61 years), and 19 healthy subjects (mean age; 40.26 +/- 5.11 years) served as controls. Anti-CCP antibodies and Anti-MCV antibodies were measured using ELISA. In all RA patients, mean anti- CCP level was 69.07 +/- 90.43 U/ml and anti-MCV level was 665.77 +/- 1040.19 U/ml. In patients with AS, the mean anti-CCP level was 10.7 +/- 5.22 U/ml and anti-MCV level was 40.54 +/- 20.15 U/ml. In healthy controls, the mean anti-CCP level was 11.11 +/- 7.65 U/ml, anti-MCV level was 23.12 +/- 12.04 U/ml. In patients with active RA, the mean serum anti-CCP level was 100.54 +/- 98.07 U/ml and anti-MCV level was 998.74 +/- 1154.93 U/ml. In patients with inactive RA, the mean serum anti-CCP level was 8.77 +/- 1.55 U/ml and anti-MCV level was 27.59 +/- 23.10 U/ml. According to these results; In patients with RA, the mean serum anti-MCV and anti-CCP levels were significantly high compared to patients with AS and healthy controls (p=0.002, p=0.001, p=0.002, p=0.001 respectively). The mean serum anti-MCV and anti- CCP levels were significantly higher in active patients with RA than in inactive patients with RA patients (p=0.001 and p=0.001 respectively). In inactive patients with RA, the mean serum anti-MCV and anti-CCP levels were similar in patients with AS and patients (p=0.484, p=0.308, p=0.09 and p=0.222 respectively). The mean serum anti-MCV levels were correlated with DAS 28 (r=0.531, p=0.001), VAS score (r=0.332, p=0.01), ESR (r=0.458, p=0.001), serum CRP levels (r=0.568, p=0.01), serum RF levels (r=0.529, p=0.001), swollen joints number (r=0.525, p=0.001) and tender joints number (r=0.638, p=0.001). As a result; measurement of serum anti-MCV levels is useful for diagnosis of RA and combined use of anti-MCV and RF may be more useful prognostic factor than either method alone, RF and anti-CCP.
引自：Diagnostic utility of anti-cyclic citrullinated peptide and anti-modified citrullinated vimentin antibodies in rheumatoid arthritis. Protein Pept Lett. 2008;15(3):314-7.
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