Department of Biomolecular Chemistry 271, Nijmegen Center for Molecular Life Sciences, Institute for Molecules and Materials, Radboud University Nijmegen, PO Box 9101, NL-6500 HB Nijmegen, the Netherlands.
Arthritis Res Ther. 2010;12(1):203. doi: 10.1186/ar2903. Epub 2010 Feb 15.
The presence or absence of antibodies to citrullinated peptides/proteins (ACPA) is an important parameter that helps a clinician set a diagnosis of early rheumatoid arthritis and, hence, initiate treatment. There are several commercial tests available to measure ACPA levels, although it can be difficult to decide what the best test for a given clinical question is. We analyzed literature data in which the diagnostic and other properties of various ACPA tests are compared. The results show that for diagnostic purposes the CCP2 test has the highest specificity, the highest sensitivity in stratified studies and the highest positive predictive value. For the prediction of future joint destruction the CCP2, MCV, and CCP3 tests may be used. The ability to predict the likelihood of not achieving sustained disease-modifying antirheumatic drug-free remission was highest for the CCP2 test. Finally, the levels of anti-CCP2 and anti-CCP3 (and possibly anti-mutated citrullinated vimentin) in rheumatoid arthritis patients are not significantly influenced by TNFalpha blocking agents.
抗瓜氨酸化肽/蛋白抗体（ACPA）的存在与否是帮助临床医生确定早期类风湿关节炎诊断并因此开始治疗的一个重要参数。有几种商业检测方法可用于测量 ACPA 水平，但要确定针对特定临床问题的最佳检测方法可能会有困难。我们分析了比较各种 ACPA 检测方法的诊断和其他特性的文献数据。结果表明，就诊断目的而言，CCP2 检测具有最高的特异性、分层研究中的最高敏感性和最高的阳性预测值。对于预测未来的关节破坏，CCP2、MCV 和 CCP3 检测可能有用。对于预测无法实现持续缓解（无疾病修饰抗风湿药物）的可能性，CCP2 检测的能力最高。最后，类风湿关节炎患者的抗 CCP2 和抗 CCP3 （可能还有抗突变瓜氨酸化波形蛋白）水平不受 TNFalpha 阻断剂的显著影响。
