Clinical use of anti-cyclic citrullinated peptide antibody testing.
Clinical use of anti-cyclic citrullinated peptide antibody testing.
复制标题
临床使用抗环瓜氨酸肽抗体检测。
DOI：
10.1097/rhu.0b013e3182a22418
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Shmerling,RobertH
中科院分区：
文献类型：
--
作者：
Peoples,Christine;Valiyil,Ritu;Davis,RogerB;Shmerling,RobertH
类风湿因子(RF)对RA的诊断既不是高度敏感的，也不是高度特异的。4Y9美国风湿病学会和欧洲风湿病联盟更新的类风湿性关节炎分类标准包括RF和抗Y环瓜氨酸肽抗体(ACAs)。抗Y环瓜氨酸肽抗体因其较高的特异性而越来越多地被用作RA、2、10的诊断试验。2、5、10年13已初步研究了ACAS对已确诊的类风湿关节炎和其他风湿性疾病患者的诊断作用。我们的目标是评估ACA测试的频率，并评估该测试在临床医生实际为其安排测试的患者中的诊断效用。患者是通过贝丝以色列女执事医疗中心(波士顿，马萨诸塞州)的实验室收到的请求确定的。回顾了2005年1月1日至2005年7月1日和2007年1月1日至2007年7月1日期间要求进行ACA检测的所有患者的记录。类风湿性关节炎患者符合美国风湿病学会1987年的分类标准14和/或由工作人员风湿科医生诊断。由Quest Diagnostics(Nichols Institute，Chantilly，VA)使用第二代测试进行测试。ACA结果为阴性<20U，弱阳性20~39U，中度阳性40~59U，强阳性60U或更高。计算了3组患者的敏感度、特异度和预测值：所有受试者、新诊断的类风湿性关节炎和确诊的类风湿性关节炎。在测试后6个月内未诊断出类风湿性关节炎的患者被指定为“无类风湿性关节炎”。检查每个患者的记录以确定先前诊断为类风湿性关节炎以及在测试指令6个月后最终诊断为类风湿关节炎。计算灵敏度、特异度、阳性预测值(PPV)和阴性预测值(NPV)。用McNemar检验比较类风湿因子和ACA结果。总共订购了ACA测试，其中79%是在最近的队列中订购的。大多数订购医生(92%)是风湿科医生或风湿学实习生；风湿科医生对97%的患者进行了评估。患者平均年龄49岁(16Y93岁)，其中77%为女性。大多数测试(80%)被要求评估关节痛。在确诊的类风湿性关节炎患者中进行了61次测试(11%)。
Rheumatoid factor (RF) is neither highly sensitive nor specific for the diagnosis of RA. 4Y9 The American College of Rheumatology and European League Against Rheumatism updated criteria for the classification of RA include RF and antiYcyclic citrullinated peptide antibodies (ACAs). AntiYcyclic citrullinated peptide antibodies have been increasingly utilized as a diagnostic test for RA, 2, 10 largely because of their higher specificity. 2, 5, 10Y13 The diagnostic utility of ACAs has been studied primarily in patients with established RA and other rheumatic diseases. Our objective was to assess the frequency of ACA testing and evaluate the test’s diagnostic utility among patients for whom clinicians actually ordered the test. Patients were identified through requests received by the laboratory of Beth Israel Deaconess Medical Center (Boston, MA). The records of all patients for whom ACA testing was requested from January 1, 2005, to July 1, 2005, and January 1, 2007, to July 1, 2007, were reviewed. Patients with RA met the American College of Rheumatology 1987 classification criteria14 and/or were diagnosed by a staff rheumatologist. Tests were performed by Quest Diagnostics (Nichols Institute, Chantilly, VA) using a secondgeneration assay.A negative ACA result was less than 20 U, weakly positive 20 to 39 U, moderately positive 40 to 59 U, and strongly positive 60 U or greater. Sensitivity, specificity, and predictive values were calculated for 3 groups of patients: all subjects, newly diagnosed RA, and established RA. Patients without a diagnosis of RA within 6 months of testing were designated ‘‘no RA.’’Records for each patient were reviewed to identify a prior diagnosis of RA and the ultimate diagnosis 6 months after the test order. Sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) were calculated. Rheumatoid factor and ACA results were compared using McNemar test. A total of 535 ACA tests were ordered, 79% of which were ordered in the more recent cohort. Most ordering physicians (92%) were rheumatologists or rheumatology trainees; a rheumatologist evaluated 97% of patients. Average patient age was 49 years (range, 16Y93 years), and 77% were female. Most tests (80%) were ordered to evaluate arthralgia. Sixty-one tests (11%) were ordered among patients with established RA.
影响因子：
27.4
作者：
Bas, S;Perneger, TV;Vischer, TL
通讯作者：
Vischer, TL