| ObjectiveTo investigate the diagnostic value of anti-mutated citrullinated vimentin antibody (anti-MCV) in rheumatoid arthritis (RA). While exploring the relationship between anti-MCV antibody and the RA activity assessment and RA interstitial lung disease.MethodsThe researth subjects were divided into three groups, RA group, non-RA group and the healthy control group. The RA group had75patients which came from the Department Rheumatology of Zhuzhou central hospital from November of2013to March of2014. The RA diagnosis was based on the RA revision classification standard of American Rheumatology (ACR) in1987or the new RA classification standard of ACR and the European League Against Rheumatism (EULAR) proposed in2009. The non-RA group had81patients with other connective tissue diseases which came form the Department Rheumatology of Zhuzhou central hospital at the same time. All patients met the diagnostic criteria of connective tissue disease recognized at home and abroad. The healthy control group had60cases which came from the physical examination center of Zhuzhou central hospital. All subjects were collected fasting elbow venous blood3ml, collecting serum after centrifugation, then preserving the serum for mass detection. To detect the serum anti-MCV antibody, anti-cyclic citrullinated peptide (CCP) antibody, rheumatoid factor IgA (RF-IgA), rheumatoid factor IgG (RF-IgG), rheumatoid factor IgM (RF-IgM) of RA group and non-RA group using enzyme-linked immunosorbent assay (ELISA), and detecting anti-keratin antibody (AKA), anti perinuclear factor (APF) using indirect immunofluorescence assay (IIF). To detect the anti-MCV antibody and anti-CCP antibody of healthy control group. To evaluate the diagnostic value of anti-MCV antibody and anti-CCP antibody in RA through the receiver operating characteristic curve (ROC curve). At the same time, analyzing the correlation of anti-MCV antibody and anti-CCP antibody, RF-IgA, RF-IgG, RF-IgM, AKA, APF. We also collected the clinical data (gender, age, disease duration, number of swollen joints, number of tender joints,28joint disease activity score), laboratory data (ESR, C reactive protein) and ultrasonic data (gray scale semi-quantitative score, Doppler semi-quantitative score, ultrasound synovitis total semi-quantitative score, bone erosion number). Analyzing the relationship of the anti-MCV antibody to RA clinic data and ultrasound data. Finally, we analyzed the relationship of the anti-MCV antibody to RA interstitial lung disease (ILD) and established the Logistic regression equation of RA interstitial lung disease to screening the risk factors of RA-ILD.Results1). Positive rates of each antibody:the positive rates of anti-MCV antibody, anti-CCP antibody, RF-IgA, RF-IgQ RF-IgM, AKA, APF in RA group (85.33%,77.33%,74.67%,16%,88%,44%,68%) were significantly higher than those in non-RA group (12.35%,2.47%,16.05%,0%,25%,2.47%,2.47%, P<0.05). The positive rates of anti-MCV antibody and anti-CCP antibody in RA group (85.33%,77.33%) were significantly higher than those in the healthy control group (1.67%,0%, P <0.05). The positive rate of anti-MCV antibody in the non-RA group was higher than that of the control group (12.35%VS1.67%, P<0.025). The positive rate of anti-CCP antibody in the non-RA group was higher than that of the control group (2.47%VS0%, P>0.025).2). The diagnostic value of anti-MCV antibody and anti-CCP antibody:The sensitivity of anti-MCV antibody (85.33%) was higher than that of anti-CCP antibody (77.33%), but the difference had no statistically significant (P>0.05). The specificity of anti-MCV antibody (92.2%) was lower than that of anti-CCP antibody (98.58%), the difference had statistically significant (P<0.05). The Youden index of the two were0.7591and0.7753, the total coincidence rate of the two were0.8981and0.9120. The sensitivity and specificity of the combined detection of anti-MCV antibody and anti-CCP antibody were93.33%and92.2%, Excepting the specificity was lower than the anti-CCP antibody, the total coincidence rate and Youden index were the highest, respectively 0.9259,0.8553.3)The ROC curve of anti-MCV antibody and anti-CCP antibody:If the control group was the healthy group, the area under ROC curve (AUC) of anti-MCV antibody and anti-CCP antibody were0.971,0.953, compared with the area0.5of no diagnostic value had statistically significant (P=0.000<0.05). That indicated both anti-MCV antibody and anti-CCP antibody had high accuracy, and the anti-MCV antibody was greater than the anti-CCP antibody. If the control group was the non-RA group, the area under ROC curve (AUC) of anti-MCV antibody and anti-CCP antibody were0.940,0.908, compared with the area0.5of no differential diagnostic value had statistically significant (P=0.000<0.05). That indicated both anti-MCV antibody and anti-CCP antibody could effectively identify RA and non-RA patients, the differential diagnosis value was high, and the identification ability of anti-MCV antibody was higher than anti-CCP antibody. The diagnostic boundary value of anti-MCV antibody and anti-CCP antibody in our laboratory were16.5U/ml and26.5RU/ml according to the ROC curve which similar to the accepted diagnostic boundary value.4) The results of correlation analysis:the strongest correlation was the anti-MCV antibody and anti-CCP antibody (r=0.369, P=0.001), followed by AKA, RF-IgA, APF (r=0.349,0.247,0.247, P<0.05). There was no correlation between anti-MCV antibody and disease course, age, gender, swollen joint count, tender joint count, DAS28score, ESR, C reactive protein (P>0.05). Correlation of the anti-MCV antibody and ultrasonic gray scale semi-quantitative score was r=0.540(P=0.000), followed by AKA, anti-CCP antibody (r=0.326,0.245, P<0.05). Correlation of the anti-MCV antibody and ultrasonic Doppler semi-quantitative score was r=0.692(P=0.000), followed by AKA, anti-CCP antibody (r=0.362,0.250, P<0.05). Correlation of the anti-MCV antibody and ultrasonic synovitis total semi-quantitative score was r=0.616(P=0.000), followed by AKA, APF, anti-CCP antibody (r=0.333,0.272,0.248, P<0.05). Correlation of the anti-MCV antibody and bone erosion number was r=0.540(P=0.000), followed by disease course, AKA, anti-CCP antibody (r=0.327,0.326,0.245, P<0.05). 5) The anti-MCV antibody and RA interstitial lung disease (ILD): The positive rates of anti-MCV antibody and RF-IgA in RA-ILD group (100%,78.38%) were significantly higher than that in non RA-ILD group (71.05%,71.05%, P<0.05). The positive rates of anti-CCP antibody, RF-IgG, RF-IgM, AKA, APF in RA-ILD group(81.08%,21.62%,54.5%,72.97%) were higher than that in non RA-ILD group (73.68%,10.53%,86.84%,34.21%,63.16%), but the difference had no statistically significant (P>0.05). Through logistic regression analysis, RF-IgA, anti-MCV antibody, DAS28score and age were the risk factors of RA-ILD which screening from14possible risk factors (gender, age, disease course, DAS28score, anti-CCP antibody, anti-MCV antibody, RF-IgA, RF-IgG, RF-IgM, AKA, APF, ultrasonic gray scale score, ultrasonic Doppler score, the number of bone erosion). The OR value of anti-MCV antibody, DAS28score, RF-IgA and age were1039.368,13.409,5.358and1.607(P<0.05).ConclusionThe anti-MCV antibody has high diagnostic value in RA and has close relationship with joints ultrasonic synovitis and bone erosion number. Also, the high titer of anti-MCV antibody indicates the occurrence of interstitial lung disease. To make a long story short, the anti-MCV antibody has important value in the diagnosis, activity and prognosis evaluation of RA. |
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