抗环瓜氨酸肽抗体对类风湿关节炎的诊断价值：一项荟萃分析

[Diagnostic value of anti-cyclic citrullinated peptide antibody for rheumatoid arthritis: a meta-analysis].

作者信息

Huang Qing-shui, Wan La-gen, Luo Zhong-qin, Le Ai-ping, Wang Wen-qiang

机构信息

Department of Clinical Laboratory, First Affiliated Hospital of Nanchang University, Nanchang 330006, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2006 Aug 22;86(31):2182-7.

PMID:17064503

Abstract

OBJECTIVE

To evaluate the diagnostic value of anti-cyclic citrullinated peptide (CCP) antibody for rheumatoid arthritis.

METHODS

Data about RA from January 2000 to December 2005 were retrieved through Cochrane Library, Pubmed database, Excerpta Medica Database (EMBASE), OVID database, and China National Knowledge Infrastructure (CNKI), especially through the Annul of the Rheumatic Disease and relevant gray literatures, by entering the words "cyclic citrullinated peptides", "rheumatoid arthritis", "sensitivity", and "specificity". The inclusion of qualified literatures was based on the criteria for diagnostic research recommended by the Cochrane Methods Group on Screening and Diagnostic Test. Statistical analysis wes performed by employing the softwares of MATLAB and Review Manager 4, 2, and summary receiver operation characteristic (SROC) curve method.

RESULTS

Twenty-two articles, 15 in English and 7 in Chinese, were extracted. The reported sensitivity of anti-CCP for the diagnosis of RA ranged from 39.2% to 84.6%, and the reported specificity ranged from 90% to 97.9%. The heterogeneity of the included articles was tested, a proper effect model was selected to calculate the pooled weighted sensitivity and specificity with 95% confidence interval for anti-CCP antibody as 77.3% (63.1%, 89.2%) and 93.85% (85.5%, 98.1%), and the positive and negative likelihood ratios as 12.0 and 0.24 respectively. The area under the curve of SROC was 0.8976, and the Q value was 0.87. The sensitivity of the patients with the duration of illness < 1 year was 43%, significantly lower than that of the patients with a duration of illness > 1 year (70.2%, P < 0.01); and the specificity of the patients with the duration of illness < 1 year was 94.2%, not significantly different from that of the patients with the duration of illness > 1 year (95.2%, P = 0.94).

CONCLUSION

With relatively high sensitivity and specificity, anti-CCP antibody may be a useful parameter in the clinical diagnosis pf RA.

摘要

目的

评估抗环瓜氨酸肽（CCP）抗体对类风湿关节炎的诊断价值。

方法

通过Cochrane图书馆、Pubmed数据库、医学文摘数据库（EMBASE）、OVID数据库和中国知网（CNKI）检索2000年1月至2005年12月有关类风湿关节炎的数据，特别是通过《风湿病年鉴》及相关灰色文献，输入“环瓜氨酸肽”“类风湿关节炎”“敏感性”和“特异性”等关键词。合格文献的纳入基于Cochrane筛查与诊断试验方法组推荐的诊断研究标准。采用MATLAB软件和Review Manager 4.2进行统计分析，并采用汇总接受者操作特征（SROC）曲线法。

结果

共提取22篇文章，其中英文15篇，中文7篇。报道的抗CCP抗体诊断类风湿关节炎的敏感性为39.2%至84.6%，特异性为90%至97.9%。对纳入文章的异质性进行检验，选择合适的效应模型计算抗CCP抗体的合并加权敏感性和特异性，95%置信区间分别为77.3%（63.1%，89.2%）和93.85%（85.5%，98.1%），阳性和阴性似然比分别为12.0和0.24。SROC曲线下面积为0.8976，Q值为0.87。病程<1年患者的敏感性为43%，显著低于病程>１年患者（70.2%，P<0.01）；病程<1年患者的特异性为94.2%，与病程>1年患者（95.2%，P=0.94）无显著差异。