荟萃分析：抗环瓜氨酸肽抗体和类风湿因子对类风湿关节炎的诊断准确性

Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis.

作者信息

Nishimura Kunihiro, Sugiyama Daisuke, Kogata Yoshinori, Tsuji Goh, Nakazawa Takashi, Kawano Seiji, Saigo Katsuyasu, Morinobu Akio, Koshiba Masahiro, Kuntz Karen M, Kamae Isao, Kumagai Shunichi

机构信息

Department of Health Policy Management, Harvard School of Public Health, Boston, Massachusetts 02215, USA.

出版信息

Ann Intern Med. 2007 Jun 5;146(11):797-808. doi: 10.7326/0003-4819-146-11-200706050-00008.

DOI:10.7326/0003-4819-146-11-200706050-00008

PMID:17548411

Abstract

BACKGROUND

Rheumatoid factor (RF) and autoantibodies against cyclic citrullinated peptide (CCP) are markers that might help physicians diagnose rheumatoid arthritis.

PURPOSE

To determine whether anti-CCP antibody more accurately identifies patients with rheumatoid arthritis and better predicts radiographic progression than does RF.

DATA SOURCES

MEDLINE through September 2006 and reference lists of retrieved studies and review articles.

STUDY SELECTION

Studies in any language that enrolled at least 10 participants and that examined the role of anti-CCP antibody and RF in the diagnosis or prognosis of known or suspected rheumatoid arthritis.

DATA EXTRACTION

Two authors independently evaluated studies for inclusion, rated methodological quality, and abstracted relevant data.

DATA SYNTHESIS

The DerSimonian-Laird random-effects method was used to summarize sensitivities, specificities, and positive and negative likelihood ratios from 37 studies of anti-CCP antibody and 50 studies of RF. The pooled sensitivity, specificity, and positive and negative likelihood ratios for anti-CCP antibody were 67% (95% CI, 62% to 72%), 95% (CI, 94% to 97%), 12.46 (CI, 9.72 to 15.98), and 0.36 (CI, 0.31 to 0.42), respectively. For IgM RF, the values were 69% (CI, 65% to 73%), 85% (CI, 82% to 88%), 4.86 (CI, 3.95 to 5.97), and 0.38 (CI, 0.33 to 0.44). Likelihood ratios among IgM RF, IgG RF, and IgA RF seemed to be similar. Results from studies of patients with early rheumatoid arthritis were similar to those from all studies. Three of 4 studies found that risk for radiographic progression was greater with anti-CCP antibody positivity than with IgM RF positivity.

LIMITATIONS

Many studies had methodological limitations. Studies of RF were heterogeneous and had wide ranges of sensitivity and specificity.

CONCLUSIONS

Anti-CCP antibodies are more specific than RF for diagnosing rheumatoid arthritis and may better predict erosivedisease.

摘要

背景

类风湿因子（RF）和抗环瓜氨酸肽（CCP）自身抗体是有助于医生诊断类风湿性关节炎的标志物。

目的

确定抗CCP抗体在识别类风湿性关节炎患者方面是否比RF更准确，以及在预测影像学进展方面是否更优。

数据来源

截至2006年9月的MEDLINE以及检索到的研究和综述文章的参考文献列表。

研究选择

纳入至少10名参与者且研究抗CCP抗体和RF在已知或疑似类风湿性关节炎诊断或预后中作用的任何语言的研究。

数据提取

两位作者独立评估研究是否纳入、评定方法学质量并提取相关数据。

数据综合

采用DerSimonian-Laird随机效应方法汇总来自37项抗CCP抗体研究和50项RF研究的敏感性、特异性以及阳性和阴性似然比。抗CCP抗体的合并敏感性、特异性以及阳性和阴性似然比分别为67%（95%CI，62%至72%）、95%（CI，94%至97%）、12.46（CI，9.72至15.98）和0.36（CI，0.31至0.42）。对于IgM RF，相应的值分别为69%（CI，65%至73%）、85%（CI，82%至88%）、4.86（CI，3.95至5.97）和0.38（CI，0.33至0.44）。IgM RF、IgG RF和IgA RF之间的似然比似乎相似。早期类风湿性关节炎患者的研究结果与所有研究的结果相似。4项研究中的3项发现，抗CCP抗体阳性患者的影像学进展风险高于IgM RF阳性患者。