中华检验医学杂志
中華檢驗醫學雜誌
중화검험의학잡지
CHINESE JOURNAL OF LABORATORY MEDICINE
2014年
6期
455-458
,共4页
刘毓刚%吴丽娟%胡宗海%陈莉%彭燕
劉毓剛%吳麗娟%鬍宗海%陳莉%彭燕
류육강%오려연%호종해%진리%팽연
脊柱炎,强直性%肽类,环%波形蛋白%突变%类风湿因子
脊柱炎,彊直性%肽類,環%波形蛋白%突變%類風濕因子
척주염,강직성%태류,배%파형단백%돌변%류풍습인자
Spondylitis,ankylosing%Peptides,cyclic%Vimentin%Mutation%Rheumatoid factor
目的：探讨抗突变型瓜氨酸波形蛋白（MCV）抗体和抗环瓜氨酸肽（CCP）抗体对强直性脊柱炎（AS）的诊断价值，并建立基于抗瓜氨酸蛋白/肽抗体（ ACPAs）检测的新的AS诊断方法。方法通过诊断性研究，ELISA法检测121例AS患者（ AS组）、97例RA患者（ RA组）、103名健康体检者（健康对照组）血清抗MCV抗体及抗CCP抗体，流式细胞法检测AS患者淋巴细胞表面HLA-B27表达，速率散射免疫比浊法检测RA患者和AS患者血清类风湿因子IgM（RF-IgM），利用受试者工作特征（ ROC）曲线分析抗MCV抗体对AS的诊断价值，确定诊断临界值。各组间抗MCV抗体及抗CCP抗体比较采用非参数Mann-Whitney U检验，率的比较用χ2检验或Fisher 精确检验。结果AS组血清抗MCV抗体水平18.13（12.36～25.83） U/ml显著高于健康对照组11.60（8.41～13.54） U/ml（U＝2413，P＜0.001），而抗CCP抗体水平在两组间[AS组6.22（4.30～8.07）U/ml，健康对照组6.01（3.77～7.58）U/ml]差异无统计学意义（U＝5421，P＝0.094）；抗MCV抗体的ROC曲线下面积为0.806，14.67 U/ml为最佳的诊断临界值，采用此临界值，诊断敏感度为0.645，特异度为0.942，在HLA-B27阴性和阳性AS患者中，抗MCV抗体水平及阳性率均高于健康对照组（U＝133.5，P＝0.001；U＝2279.5，P＜0.001）；使用抗MCV抗体和抗CCP抗体、抗MCV抗体和RF-IgM联合检测鉴别诊断AS和RA的敏感度分别为60.3％（73/121）、62.8％（76/121），特异度分别为89.7％（87/97）、90.7％（88/97），特异度高于抗MCV抗体单独检测（16.5％，16/97）。结论抗MCV抗体可以作为一种新的AS血清诊断指标，确立的新AS诊断临界值具有高敏感度和特异度，且对不同HLA-B27状态的AS患者有同等的诊断效力，使用MCV抗体和抗CCP抗体（ MCV＋CCP-）或RF-IgM（ MCV＋RF-）联合检测分析可以有效对AS和RA进行鉴别诊断。（中华检验医学杂志，2014，37：455-458）
目的：探討抗突變型瓜氨痠波形蛋白（MCV）抗體和抗環瓜氨痠肽（CCP）抗體對彊直性脊柱炎（AS）的診斷價值，併建立基于抗瓜氨痠蛋白/肽抗體（ ACPAs）檢測的新的AS診斷方法。方法通過診斷性研究，ELISA法檢測121例AS患者（ AS組）、97例RA患者（ RA組）、103名健康體檢者（健康對照組）血清抗MCV抗體及抗CCP抗體，流式細胞法檢測AS患者淋巴細胞錶麵HLA-B27錶達，速率散射免疫比濁法檢測RA患者和AS患者血清類風濕因子IgM（RF-IgM），利用受試者工作特徵（ ROC）麯線分析抗MCV抗體對AS的診斷價值，確定診斷臨界值。各組間抗MCV抗體及抗CCP抗體比較採用非參數Mann-Whitney U檢驗，率的比較用χ2檢驗或Fisher 精確檢驗。結果AS組血清抗MCV抗體水平18.13（12.36～25.83） U/ml顯著高于健康對照組11.60（8.41～13.54） U/ml（U＝2413，P＜0.001），而抗CCP抗體水平在兩組間[AS組6.22（4.30～8.07）U/ml，健康對照組6.01（3.77～7.58）U/ml]差異無統計學意義（U＝5421，P＝0.094）；抗MCV抗體的ROC麯線下麵積為0.806，14.67 U/ml為最佳的診斷臨界值，採用此臨界值，診斷敏感度為0.645，特異度為0.942，在HLA-B27陰性和暘性AS患者中，抗MCV抗體水平及暘性率均高于健康對照組（U＝133.5，P＝0.001；U＝2279.5，P＜0.001）；使用抗MCV抗體和抗CCP抗體、抗MCV抗體和RF-IgM聯閤檢測鑒彆診斷AS和RA的敏感度分彆為60.3％（73/121）、62.8％（76/121），特異度分彆為89.7％（87/97）、90.7％（88/97），特異度高于抗MCV抗體單獨檢測（16.5％，16/97）。結論抗MCV抗體可以作為一種新的AS血清診斷指標，確立的新AS診斷臨界值具有高敏感度和特異度，且對不同HLA-B27狀態的AS患者有同等的診斷效力，使用MCV抗體和抗CCP抗體（ MCV＋CCP-）或RF-IgM（ MCV＋RF-）聯閤檢測分析可以有效對AS和RA進行鑒彆診斷。（中華檢驗醫學雜誌，2014，37：455-458）
목적：탐토항돌변형과안산파형단백（MCV）항체화항배과안산태（CCP）항체대강직성척주염（AS）적진단개치，병건립기우항과안산단백/태항체（ ACPAs）검측적신적AS진단방법。방법통과진단성연구，ELISA법검측121례AS환자（ AS조）、97례RA환자（ RA조）、103명건강체검자（건강대조조）혈청항MCV항체급항CCP항체，류식세포법검측AS환자림파세포표면HLA-B27표체，속솔산사면역비탁법검측RA환자화AS환자혈청류풍습인자IgM（RF-IgM），이용수시자공작특정（ ROC）곡선분석항MCV항체대AS적진단개치，학정진단림계치。각조간항MCV항체급항CCP항체비교채용비삼수Mann-Whitney U검험，솔적비교용χ2검험혹Fisher 정학검험。결과AS조혈청항MCV항체수평18.13（12.36～25.83） U/ml현저고우건강대조조11.60（8.41～13.54） U/ml（U＝2413，P＜0.001），이항CCP항체수평재량조간[AS조6.22（4.30～8.07）U/ml，건강대조조6.01（3.77～7.58）U/ml]차이무통계학의의（U＝5421，P＝0.094）；항MCV항체적ROC곡선하면적위0.806，14.67 U/ml위최가적진단림계치，채용차림계치，진단민감도위0.645，특이도위0.942，재HLA-B27음성화양성AS환자중，항MCV항체수평급양성솔균고우건강대조조（U＝133.5，P＝0.001；U＝2279.5，P＜0.001）；사용항MCV항체화항CCP항체、항MCV항체화RF-IgM연합검측감별진단AS화RA적민감도분별위60.3％（73/121）、62.8％（76/121），특이도분별위89.7％（87/97）、90.7％（88/97），특이도고우항MCV항체단독검측（16.5％，16/97）。결론항MCV항체가이작위일충신적AS혈청진단지표，학립적신AS진단림계치구유고민감도화특이도，차대불동HLA-B27상태적AS환자유동등적진단효력，사용MCV항체화항CCP항체（ MCV＋CCP-）혹RF-IgM（ MCV＋RF-）연합검측분석가이유효대AS화RA진행감별진단。（중화검험의학잡지，2014，37：455-458）
Objective To investigate the diagnostic value of anti-mutated citrullinated vimentin (anti-MCV) and anti-cyclic citrullinated peptide (anti-CCP) antibodies for ankylosing spondylitis (AS), and to establish a new diagnostic method of AS based on anti-citrullinated protein/peptide antibodies (ACPAs) detection.Methods Totally 121 AS patients(AS group), 97 rheumatoid arthritis(RA) patients (RA group)and 103 healthy people(control group) were enrolled for the detection of serum levels of anti-MCV and anti-CCP antibodies using ELISA method as a diagnostic test .HLA-B27 in AS patients was tested by flow cytometry , and RF-IgM in RA and AS patients was detected by immune rate nephelometry .Receiver operating characteristics ( ROC) curve was used to analyze the diagnostic value and to determine the cut-off value.Anti-MCV and anti-CCP antibodies among each group were compared by Mann-Whitney U test, Chi-square test or Fisher′s exact test was used to compare positive rate .Results The anti-MCV levels in AS group [11.60 ( 12.36-25.83 ) U/ml ] were significantly higher than control group [ 11.60 ( 8.41 -13.54)U/ml ],U=2 413,P <0.001, while the levels of anti-CCP had no difference between the two groups [AS group 6.22 (4.30 -8.07) U/ml], and control group [6.01 (3.77 -7.58) U/ml], respectively;U=5 421,P=0.094.The calculated area under the ROC curve of anti-MCV was 0.806,and 14.67 U/ml was the optimal cut-off value with sensitivity of 0.645 and specificity of 0.942.In both HLA-B27 positive and negative AS patients , anti-MCV antibodies levels and positive rate were significantly higher than control group using new cut-off value above (U =133.5, P =0.001; U =2 279.5,P <0.001). Sensitivity of the combination detection of anti-MCV and anti-CCP ( MCV+CCP-) or RF-IgM ( MCV+RF-) were 60.3%(73/121), 62.8% (76/121) and specificity were 89.7% (87/97), 90.7% (88/97) respectively in differential diagnosis of AS and RA , which were significantly higher than anti-MCV detection alone in specificity (16.5%,16/97).Conclusions Anti-MCV could be a new biomarker for the diagnosis of AS .With high sensitivity and specificity , anti-MCV has an equal diagnostic efficiency in HLA-B27 positive and negative AS patients using our new cut-off value.Additionally, the combination detection of anti-MCV and anti-CCP or RF-IgM could be an effective method for differential diagnosis of AS and RA .
