Anti-CCP antibodies have more diagnostic impact than rheumatoid factor (RF) in a population tested for RF
Anti-CCP antibodies have more diagnostic impact than rheumatoid factor (RF) in a population tested for RF
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DOI：
10.1007/s10067-007-0601-6
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发表时间：
2007-11-01
影响因子：
3.4
通讯作者：
Staub, H. L.
中科院分区：
文献类型：
--
作者：
Silveira, I. G.;Burlingame, R. W.;Staub, H. L.
为了比较类风湿因子(RF)和抗环瓜氨酸肽(CCP)在被选为具有高度统计学相关性的人群中的诊断能力，在6个月的时间里，从大学实验室为其订购类风湿因子(RF)和抗环瓜氨酸肽(CCP)的1025名患者获得了抗CCP测试的知情同意。在1年内，在没有通知医生抗CCP结果的情况下获得了诊断。进行了广泛的统计分析。共有768名患者符合纳入标准，132名患者被归类为类风湿性关节炎，预测检验类风湿性关节炎的概率为17%。抗CCP和RF的敏感性分别为62和(P=0.83)，特异性分别为97%和90%(P<；0.001)。抗CCP抗体阳性预测值为79%，RF阳性预测值为56%(P<；0.001)，阴性预测值均为92%。抗CCP和RF的似然比(LR)分别为17.9和6.2(P<；0.005)。40例类风湿关节炎患者被诊断为病程小于2年的类风湿关节炎，抗CCP抗体与类风湿因子的差异有统计学意义。将两个测试的结果放在一起，或者使用不同的截止点，增加了测试的诊断效用。在临床不同人群中，抗CCP试验在统计学上显示RA的特异性、PPV和LR显著高于RF试验。如果要设计新的标准来帮助诊断早期RA，应该包括抗CCP，因为它比RF具有更大的诊断影响。
To compare the diagnostic powers of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) in a population selected for its high statistical relevance, over a 6-month period, an informed consent to test for anti-CCP was obtained from 1,025 consecutive patients for whom RF was ordered at a University laboratory. Within 1 year, a diagnosis was obtained without informing the physician about the anti-CCP result. Extensive statistical analyses were performed. A total of 768 patients satisfied the inclusion criteria, and 132 were classified as having RA, yielding a pre-test probability of RA of 17%. The sensitivities for anti-CCP and RF were 62 and 64% (P=0.83), and the specificities were 97 and 90% (P < 0.001), respectively. The positive predictive value (PPV) was 79% for anti-CCP and 56% for RF (P < 0.001), whereas the negative predictive value was 92% for both. The likelihood ratio (LR) was 17.9 for anti-CCP and 6.2 for RF (P < 0.005). Forty RA patients were diagnosed with RA of less than 2 years length, and the same significant statistic differences between anti-CCP and RF were observed. Placing the results of both tests together, or using different cutoff points, increased the diagnostic utility of the tests. The anti-CCP test has statistically shown significant higher specificity, PPV, and LR for RA than the RF test in a clinically diverse population. If new criteria are to be devised to help diagnose early RA, anti-CCP should be included because it has a greater diagnostic impact than RF.