摘要目的：探讨RA患者抗突变型瓜氨酸波形蛋白（MCV）抗体、抗CCP抗体与疾病活动度及关节骨侵蚀之间的关系，为临床诊治提供依据。方法收集634例RA患者，应用ELISA法检测血清抗MCV抗体、抗CCP抗体，采集患者同期临床及实验室资料、记录双手或足X线分期，依据DAS28评分将患者分为高度活动组、中度活动组、低度活动组和疾病稳定组。应用Wilcoxon秩和检验、Nemenyi法、Spearman相关分析进行统计学分析。结果① RA患者抗MCV抗体与ESR、CRP、关节压痛数、DAS28评分呈正相关（r=0.115，P=0.004；r=0.120，P=0.003；r=0.124，P=0.002；r=0.085，P=0.032），抗CCP抗体与上述指标均无相关性；抗MCV抗体在疾病高度活动组[694（156，1000）] U/ml和中度活动组[911（190，1000）] U/ml均高于低度活动组[248（150，731）] U/ml和疾病稳定组[275（62，928）] U/ml（U=2.29，P=0.023；U=2.25，P=0.024；U=2.45，P=0.014； U=2.4，P=0.018）；抗 CCP 抗体在疾病中度活动组[449（180，1370）] U/ml高于低度活动组[297（83，574）] U/ml和疾病稳定组[187（67，1153）] U/ml（U=2.53， P=0.012；U=2.22，P=0.026）。②抗MCV抗体、抗CCP抗体在骨侵蚀组中均高于非骨侵蚀组（U=4.64， P<0.01；U=2.69，P=0.007）；抗MCV抗体的在受累关节X线Ⅱ期[722（259，1000）] U/ml、Ⅲ期[714（216，1000）] U/ml组明显高于Ⅰ期[316（98，1000）] U/ml（U=3.46，P<0.01；U=4.28，P<0.01），抗CCP抗体则在X线Ⅱ期[394（180，1000）] U/ml、Ⅲ期[391（181，1305）] U/ml较Ⅰ期[277（98，898）] U/ml升高（U=1.99， P=0.046；U=2.92，P=0.004），Ⅲ期较Ⅳ期[218（71，911）] U/ml升高（U=2.06，P=0.041）。结论抗MCV抗体较抗CCP抗体能更好地评估病情活动，对骨侵蚀具有更好的预测价值，ESR及CRP较高者易发生骨侵蚀。

abstractsObjective To investigate the relationship between anti mutated citrullinated vimentin (MCV) antibody, anti-cyclic citrullinated peptide (CCP) antibody with disease activity and bone erosion in patients with rheumatoid arthritis (RA), so as to provide evidence for clinical diagnosis and treatment. Methods The anti-CCP antibody and anti-MCV antibody were detected using the enzyme-linked immune adsorption method (ELISA) for 634 patients with RA. At the same time, the clinical and laboratory data were collected, and the X-ray images of hands or feet were taken. Disease activity score (DAS)28 score was calculated, and all patients were divided into high disease activity group, moderatedisease activity group, low disease activity group and stable disease group on the basis of the DAS28 score. We analyzed the relationship between the&nbsp;degree of anti MCV, anti CCP antibodies, and disease activity of patients by Spearman correlation. And anti CCP, anti MCV antibodies, erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) of these patients were compared at different period of bone erosion and disease activity by the Wilcoxon rank sum test and nemenyi. Results ① Positive correlation could be detected between anti-MCV antibody and ESR, CRP, number of tender joint, DAS28 score (r=0.115, P=0.004; r=0.120, P=0.003; r=0.124, P=0.002; r=0.085, P=0.032), and anti CCP antibody had no correlation with these index. The anti MCV antibodies in high disease activity group [694 (156, 1 000)] U/ml, and moderate activity group [911 (190, 1 000)] U/ml were higher than that of the low disease activity [248(150, 731)] U/ml or stable group [275(62, 928)] U/ml (U=2.29, P=0.023;U=2.25, P=0.024; U=2.45, P=0.014; U=2.4, P=0.018), and anti CCP antibody in the moderate disease activity group [499(180, 1 370)] U/ml was higher than low disease activity group [297(83, 574)] U/ml and stable group [187(67, 1 153)] U/ml (U=2.53, P=0.012; U=2.22, P=0.026). ②The anti MCV, anti CCP antibody in the bone erosion group were higher than those without bone erosion group (U=4.64, P<0.01;U=2.69, P=0.007). The anti MCV antibodies in stage Ⅱ[722(259, 1 000)] U/ml and Ⅲ group [714 (216, 1 000)] U/ml was significantly higher than that in stage Ⅰ [316(98, 1 000)] U/ml(U=3.46, P<0.01; U=4.28, P<0.01). The anti CCP antibody level in stage Ⅱ [394(180, 1 000)] U/ml and Ⅲ[391(181,1305)] U/ml was higher compared with stage Ⅰ[277 (98,898)] U/ml (U=1.99, P=0.046; U=2.92, P=0.004), and that in phase Ⅲ was higher than Ⅳ [218(71, 911)] U/ml (U=2.06, P=0.041). Conclusion Compared with anti-CCP antibody, anti-MCV antibody is closely related with disease activity, and has a better predictive value for bone erosion. Patients with higher ESR and CRP are more susceptible to bone erosion.