Taylor Peter, Gartemann Juliane, Hsieh Jeanie, Creeden James
Kennedy Institute of Rheumatology Division, Imperial College, London W6 8LH, UK.
Autoimmune Dis. 2011;2011:815038. doi: 10.4061/2011/815038. Epub 2011 Sep 11.
This systematic review assesses the current status of anti-cyclic citrullinated peptide (anti-CCP) and rheumatoid factor (RF) tests in the diagnosis and prognosis of rheumatoid arthritis (RA). We reviewed publications on tests and biomarkers for early diagnosis of RA from English-language MEDLINE-indexed journals and non-MEDLINE-indexed sources. 85 publications were identified and reviewed, including 68 studies from MEDLINE and 17 non-MEDLINE sources. Anti-CCP2 assays provide improved sensitivity over anti-CCP assays and RF, but anti-CCP2 and RF assays in combination demonstrate a positive predictive value (PPV) nearing 100%, greater than the PPV of either of the tests alone. The combination also appears to be able to distinguish between patients whose disease course is expected to be more severe and both tests are incorporated in the 2010 ACR Rheumatoid Arthritis Classification Criteria. While the clinical value of anti-CCP tests has been established, differences in cut-off values, sensitivities and specificities exist between first-, second- and third-generation tests and harmonization efforts are under way. Anti-CCP and RF are clinically valuable biomarkers for the diagnosis and prognosis of RA patients. The combination of the two biomarkers in conjunction with other clinical measures is an important tool for the diagnosis and management of RA patients.
本系统评价评估了抗环瓜氨酸肽（anti-CCP）和类风湿因子（RF）检测在类风湿关节炎（RA）诊断和预后中的现状。我们检索了英文MEDLINE索引期刊及非MEDLINE索引来源中有关RA早期诊断检测和生物标志物的文献。共识别并检索了85篇文献，其中包括来自MEDLINE的68项研究和17项非MEDLINE来源的研究。抗CCP2检测比抗CCP检测和RF检测具有更高的敏感性，但抗CCP2检测与RF检测联合使用时显示出接近100%的阳性预测值（PPV），高于单独使用任何一种检测的PPV。这种联合检测似乎还能够区分疾病进程预计更严重的患者，且两种检测均纳入了2010年美国风湿病学会（ACR）类风湿关节炎分类标准。虽然抗CCP检测的临床价值已经确立，但第一代、第二代和第三代检测在临界值、敏感性和特异性方面存在差异，目前正在进行统一协调工作。抗CCP和RF是RA患者诊断和预后的有临床价值的生物标志物。这两种生物标志物与其他临床指标相结合是诊断和管理RA患者的重要工具。
