Immunology and Allergology Laboratory Unit, S. Giovanni di Dio Hospital, Azienda Sanitaria of Florence, Florence, Italy.
Immunology and Allergology Laboratory Unit, S. Giovanni di Dio Hospital, Azienda Sanitaria of Florence, Florence, Italy.
Clin Chim Acta. 2014 Sep 25;436:237-42. doi: 10.1016/j.cca.2014.05.019. Epub 2014 Jun 2.
ACPA (anti-citrullinated protein antibody) tests are today systematically added to clinical and radiological investigations when diagnosing rheumatoid arthritis (RA), and the inclusion of ACPA positivity in the new 2010 RA criteria underlines their importance. The aim of this study was to determine the sensitivity and specificity of different ACPA assays and IgA, IgG and IgM isotypes of rheumatoid factor (RF) in a cohort of patients with early RA in order to assess the value of combining the tests. The serum samples were obtained from 46 RA patients, 80 patients with systemic rheumatic disease, and 20 blood donors. ACPAs were measured using five different commercial kits. The receiver operating characteristic (ROC) curves of the anti-ACPA tests had area under the curve (AUC) values of 0.60-0.83. The diagnostic accuracy of the Bio-Rad multiplex flow immunoassay, a new technology for ACPA testing, was very similar to that of the other widely used commercial immunoassays. The EliA CCP-Phadia test was the most specific, and had the best positive likelihood ratio and positive predictive values, whereas the anti-CCP Inova 3.1 test was the most sensitive, and had the best negative likelihood ratio and negative predictive values. The best combination to use for early RA screening was an ACPA test together with IgM and IgA RF.
ACPA（抗瓜氨酸化蛋白抗体）检测如今在类风湿关节炎（RA）的诊断中被系统地纳入临床和放射学检查，而 ACPA 阳性在新的 2010 年 RA 标准中的纳入强调了其重要性。本研究旨在确定不同 ACPA 检测方法和 IgA、IgG 和 IgM 类风湿因子（RF）同种型在一组早期 RA 患者中的敏感性和特异性，以评估联合检测的价值。从 46 例 RA 患者、80 例系统性风湿病患者和 20 名献血者中获得血清样本。使用五种不同的商业试剂盒测量 ACPAs。抗 ACPA 检测的受试者工作特征（ROC）曲线的曲线下面积（AUC）值为 0.60-0.83。新型 ACPA 检测技术——伯乐多指标流式免疫分析的诊断准确性与其他广泛使用的商业免疫分析非常相似。EliA CCP-Phadia 检测的特异性最高，阳性似然比和阳性预测值最好，而抗 CCP Inova 3.1 检测的敏感性最高，阴性似然比和阴性预测值最好。用于早期 RA 筛查的最佳组合是 ACPA 检测与 IgM 和 IgA RF 联合使用。
