Autoantibodies to cyclic citrullinated peptide 2 (CCP2) are superior to other potential diagnostic biomarkers for predicting rheumatoid arthritis in early undifferentiated arthritis
Autoantibodies to cyclic citrullinated peptide 2 (CCP2) are superior to other potential diagnostic biomarkers for predicting rheumatoid arthritis in early undifferentiated arthritis
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DOI：
10.1007/s10067-007-0558-5
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发表时间：
2007-10-01
影响因子：
3.4
通讯作者：
Saeki, Yukihiko
中科院分区：
文献类型：
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作者：
Kudo-Tanaka, Eriko;Ohshima, Shiro;Saeki, Yukihiko
我们评价了抗环瓜氨酸多肽2(抗CCP2)抗体和其他潜在的诊断生物标志物(IgM类风湿因子、抗无半乳糖抗体、基质金属蛋白酶3、C反应蛋白)在预测类风湿关节炎(RA)早期发展中的诊断价值。如果患者在过去2年内发生了两个或两个以上关节的关节炎，并且不能被归类为明确的关节病，则患者被定义为新近发病的未分化关节炎(UA)。在研究开始时采集的血液样本中测量生物标记物的基线水平，并对患者进行为期1年的跟踪调查，以监测RA的发展。类风湿性关节炎和非类风湿性关节炎的诊断根据个人标准诊断标准进行。共有146名患者参加了这项研究。在随访一年中，18名患者发展为类风湿性关节炎，54名患者发展为非类风湿性关节炎，60名患者仍处于不稳定型心绞痛类别。抗CCP2抗体对RA诊断的敏感性和特异性分别为83.3%和93.0%。抗CCP2抗体对RA的阳性预测值(PPV)、阴性预测值(NPV)和诊断准确率分别为65.2%、97.2%和91.7%。与单独使用抗CCP2抗体相比，联合使用抗CCP2抗体和任何其他生物标志物仅略微提高了每个诊断价值。在抗CCP2阳性患者中，RA患者的平均滴度显著高于非RA或UA患者(163.7+/-138.4 vs55.2+/-72.0U/ml，p=0.017)。抗CCP2抗体在预测新发UA患者RA早期发展方面优于任何其他单一生物标志物，其单独诊断价值与生物标志物组合的诊断价值相似。此外，抗CCP2抗体滴度有助于区分早期发展为RA的高危患者和发展为非RA关节病的高危患者。
We evaluated the diagnostic value of anti-cyclic citrullinated peptide 2 (anti-CCP2) antibodies and other potential diagnostic biomarkers (IgM rheumatoid factor, anti-agalactosyl IgG antibodies, matrix metalloproteinase 3, C-reactive protein) for predicting early development of rheumatoid arthritis (RA). Patients were defined as having recent-onset undifferentiated arthritis (UA) if they had developed arthritis in two or more joints within the previous 2 years and could not be classified with a well-defined arthropathy. Baseline levels of biomarkers were measured in blood samples collected at the entry of the study and the patients were followed for 1 year to monitor development of RA. Diagnoses of RA and non-RA arthropathies were made according to individual standard diagnostic criteria. A total of 146 patients were enrolled in the study. In the follow-up year, 18 patients developed RA, 54 developed non-RA arthropathies, and 60 remained in the UA category. The sensitivity and specificity of the presence of anti-CCP2 antibodies for the diagnosis of RA were 83.3 and 93.0%, respectively. The positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of anti-CCP2 antibodies for RA (65.2, 97.2, and 91.7%, respectively) were higher than for any other biomarker. Combination of anti-CCP2 with any other biomarker only slightly improved each diagnostic value compared to the presence of anti-CCP2 alone. Among the anti-CCP2-positive patients, the average titer was significantly higher in those with RA than in non-RA or UA patients (163.7 +/- 138.4 vs 55.2 +/- 72.0 U/ml, p=0.017). Anti-CCP2 antibodies are superior to any other single biomarker for predicting early development of RA in patients with recent-onset UA and the diagnostic value of anti-CCP2 alone is similar to that for biomarker combinations. Moreover, the anti-CCP2 antibody titer is useful to discriminate between patients at high risk for early developing RA from those at risk of developing non-RA arthropathies.