Division of Rheumatology, Chris Hani Baragwanath Hospital and University of the Witwatersrand, P.O. Bertsham, Johannesburg, South Africa.
Clin Rheumatol. 2010 Jun;29(6):615-8. doi: 10.1007/s10067-010-1374-x. Epub 2010 Feb 2.
To establish the diagnostic utility of the anti-cyclic-citrullinated peptide antibody (aCCP) test in Black South Africans with early rheumatoid arthritis (RA). A cross-sectional study comparing the rheumatoid factor (RF) and aCCP status in RA patients and a control group consisting of healthy subjects, and patients with systemic lupus erythematosus (SLE) and scleroderma. The sensitivity, specificity, positive (PPV) and negative predictive values of the aCCP test alone were 82.5%, 84.9%, 87.6% and 79% versus 81.7%, 90.7%, 92.5% and 78% for RF alone. The best specificity (95.3) and PPV (95.8%) was observed when both aCCP and RF tests were positive. Patients with erosive disease had a significantly higher mean RF titre compared with those with non-erosive disease (p = 0.007). There was a trend towards an association of smoking (OR = 4.1, 95% CI = 0.9-18.6) and functional disability (p = 0.07) with RF-positive status. No similar clinical associations were observed with aCCP. Almost a third of SLE patients were aCCP positive. Despite the best specificity and PPV observed when both the aCCP and RF tests were positive, our findings suggest that testing for aCCP is only cost-effective in the RF-negative patient in whom there is a strong clinical suspicion of RA.
为了确定抗环瓜氨酸肽抗体（aCCP）检测在南非黑人早期类风湿关节炎（RA）患者中的诊断效用。这是一项横断面研究，比较了 RA 患者和健康对照组、系统性红斑狼疮（SLE）和硬皮病患者的类风湿因子（RF）和 aCCP 状态。与单独 RF 检测相比，aCCP 检测的敏感性、特异性、阳性预测值（PPV）和阴性预测值分别为 82.5%、84.9%、87.6%和 79%，而 81.7%、90.7%、92.5%和 78%。当 aCCP 和 RF 检测均为阳性时，特异性（95.3%）和 PPV（95.8%）最佳。与非侵蚀性疾病患者相比，侵蚀性疾病患者的 RF 滴度明显更高（p = 0.007）。RF 阳性与吸烟（OR = 4.1，95%CI = 0.9-18.6）和功能障碍（p = 0.07）之间存在相关性的趋势。与 aCCP 无类似的临床关联。尽管当 aCCP 和 RF 检测均为阳性时观察到最佳的特异性和 PPV，但我们的研究结果表明，只有在 RF 阴性且强烈怀疑 RA 的患者中，检测 aCCP 才具有成本效益。
在 SLE 患者中，近三分之一的患者 aCCP 阳性。
