Low diagnostic and predictive value of anti-dsDNA antibodies in unselected patients with recent onset of rheumatic symptoms: results from a long-term follow-up Scandinavian multicentre study
Low diagnostic and predictive value of anti-dsDNA antibodies in unselected patients with recent onset of rheumatic symptoms: results from a long-term follow-up Scandinavian multicentre study
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DOI：
10.3109/03009742.2013.765032
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发表时间：
2013-01-01
影响因子：
2.1
通讯作者：
Bengtsson, A. A.
中科院分区：
文献类型：
--
作者：
Compagno, M.;Jacobsen, S.;Bengtsson, A. A.
目的：为了验证的诊断准确性的抗双链DNA（抗dsDNA）抗体检测的Crithidia luciliae免疫荧光试验（CLIFT）在一个队列中的patients，转介到风湿病学家由于最近发病的风湿symptoms.Method：共1073例连续患者进行了筛选抗核抗体（ANA）。使用两种不同的CLIFT试剂盒（ImmunoConcepts（R）和Euroimmun（R））对来自292名ANA阳性和292名匹配的ANA阴性患者的血清样品进行三次抗dsDNA抗体测试。最初的临床诊断是由不知道结果的风湿病学家做出的。诊断更新后，平均随访4.8 years.Results：CLIFT至少有一次在60例患者，但只有23例患者CLIFT阳性的所有检测。在65例患者中首次诊断为系统性红斑狼疮（SLE），其中24例（37%）CLIFT阳性。在CLIFT阳性患者中观察到许多其他诊断。总体而言，16例（5.5%）ANA阴性患者为CLIFT阳性。大约5年后，63例患者（23例CLIFT阳性）的SLE诊断保持不变，仅2例患者（1例CLIFT阳性）发生变化。在36例CLIFT阳性患者中，没有被诊断为SLE在研究进入，只有一个开发SLE在随访periods.Conclusions：CLIFT是不可靠的诊断工具，在风湿性关节炎患者的症状。在CLIFT分析之前，ANA作为筛选试验的价值不大。CLIFT对SLE诊断的阳性预测值（PPV）低得令人惊讶，尽管其特异性高。对于非SLE患者，CLIFT阳性在5年内发生SLE的风险很小。
Objectives: To verify the diagnostic accuracy of anti-double-stranded DNA (anti-dsDNA) antibodies detected by the Crithidia luciliae immunofluorescence test (CLIFT) in a cohort of unselected patients, referred to a rheumatologist due to recent onset of rheumatic symptoms.Method: A total of 1073 consecutive patients were screened for anti-nuclear antibodies (ANAs). Serum samples from 292 ANA-positive and 292 matching ANA-negative patients were tested three times for anti-dsDNA antibodies, using two different CLIFT kits (ImmunoConcepts (R) and Euroimmun (R)). An initial clinical diagnosis was made by rheumatologists unaware of the results. The diagnoses were updated after a median follow-up of 4.8 years.Results: CLIFT was positive at least once in 60 patients but only 23 patients were CLIFT positive in all of the assays. Diagnosis of systemic lupus erythematosus (SLE) was made initially in 65 patients, of whom 24 (37%) were CLIFT positive. Many other diagnoses were observed among the CLIFT-positive patients. Overall, 16 (5.5%) ANA-negative patients were CLIFT positive. After approximately 5 years, the diagnosis of SLE remained unchanged in 63 patients (23 CLIFT positive) and altered in only two (one CLIFT positive). Among the 36 CLIFT-positive patients who were not diagnosed with SLE at study entry, only one developed SLE during the follow-up period.Conclusions: CLIFT was not reliable as a diagnostic tool in unselected patients with rheumatic symptoms. ANAs were of little value as a screening test before the CLIFT analysis. CLIFT had surprisingly low positive predictive value (PPV) for the diagnosis of SLE despite its high specificity. For non-SLE patients, being CLIFT positive poses little risk of developing SLE within 5 years.