在BeSt研究中，类风湿关节炎的多生物标志物疾病活动评分可预测影像学关节损伤。
A multibiomarker disease activity score for rheumatoid arthritis predicts radiographic joint damage in the BeSt study.
作者信息
Markusse Iris M, Dirven Linda, van den Broek Marianne, Bijkerk Casper, Han K Huub, Ronday H Karel, Bolce Rebecca, Sasso Eric H, Kerstens Pit J S M, Lems Willem F, Huizinga Tom W J, Allaart Cornelia F
机构信息
From the Department of Rheumatology, Leiden University Medical Center, Leiden; Reinier de Graaf Hospital, Delft; Maasstad Hospital, Rotterdam; Haga Hospital, the Hague; Reade organization; VU Medical Center, Amsterdam, the Netherlands; Crescendo Bioscience, South San Francisco, California, USA.I.M. Markusse, MD; L. Dirven, PhD; M. van den Broek, MD, PhD, Department of Rheumatology, Leiden University Medical Center; C. Bijkerk, MD, PhD, Department of Rheumatology, Reinier de Graaf Hospital; K.H. Han, MD, Department of Rheumatology, Maasstad Hospital; H.K. Ronday, MD, PhD, Department of Rheumatology, Haga Hospital; R. Bolce, MSN; E.H. Sasso, MD, Crescendo Bioscience; P.J.S.M. Kerstens, MD, PhD, Department of Rheumatology, Reade; W.F. Lems, MD, PhD, Department of Rheumatology, Reade, and VU Medical Center; T.W.J. Huizinga, MD, PhD; C.F. Allaart, MD, PhD, Department of Rheumatology, Leiden University Medical Center.
出版信息
J Rheumatol. 2014 Nov;41(11):2114-9. doi: 10.3899/jrheum.131412. Epub 2014 Aug 15.
OBJECTIVE
To determine whether a multibiomarker disease activity (MBDA) score predicts radiographic damage progression in the subsequent year in patients with early rheumatoid arthritis.
METHODS
There were 180 serum samples available in the BeSt study (trial numbers NTR262, NTR 265): 91 at baseline (84 with radiographs available) and 89 at 1-year followup (81 with radiographs available). Radiographs were assessed using the Sharp/van der Heijde Score (SvdH). Twelve serum biomarkers were measured to determine MBDA scores using a validated algorithm. Receiver-operating curves and Poisson regression analyses were performed, with Disease Activity Score (DAS) and MBDA score as independent variables, and radiographic progression as dependent variable.
RESULTS
At baseline, MBDA scores discriminated more between patients who developed radiographic progression (increase in SvdH≥5 points) and patients who did not [area under the curve (AUC) 0.767, 95% CI 0.639-0.896] than did DAS (AUC 0.521, 95% CI 0.358-0.684). At 1 year, MBDA score had an AUC of 0.691 (95% CI 0.453-0.929) and DAS had an AUC of 0.649 (95% CI 0.417-0.880). Adjusted for anticitrullinated protein antibody status and DAS, higher MBDA scores were associated with an increased risk for SvdH progression [relative risk (RR) 1.039, 95% CI 1.018-1.059 for baseline MBDA score; 1.037, 95% CI 1.009-1.065 for Year 1 MBDA score]. Categorized high MBDA scores were also correlated with SvdH progression (RR for high MBDA score at baseline 3.7; low or moderate MBDA score as reference). At 1 year, high MBDA score gave a RR of 4.6 compared to low MBDA score.
CONCLUSION
MBDA scores predict radiographic damage progression at baseline and during disease course.
目的
确定多生物标志物疾病活动（MBDA）评分能否预测早期类风湿关节炎患者次年的影像学损伤进展。
方法
在BeSt研究中有180份血清样本（试验编号NTR262、NTR 265）：91份在基线时（84份有X线片），89份在1年随访时（81份有X线片）。使用Sharp/van der Heijde评分（SvdH）评估X线片。测量12种血清生物标志物，使用经过验证的算法确定MBDA评分。进行受试者工作曲线和泊松回归分析，以疾病活动评分（DAS）和MBDA评分为自变量，影像学进展为因变量。
结果
在基线时，与DAS（曲线下面积[AUC]0.521，95%可信区间[CI]0.358 - 0.684）相比，MBDA评分在发生影像学进展（SvdH增加≥5分）的患者和未发生进展的患者之间的区分度更高（AUC 0.767，95%CI 0.639 - 0.896）。在1年时，MBDA评分的AUC为0.691（95%CI 0.453 - 0.929），DAS的AUC为0.649（95%CI 0.417 - 0.880）。校正抗瓜氨酸化蛋白抗体状态和DAS后，较高的MBDA评分与SvdH进展风险增加相关[基线MBDA评分的相对风险（RR）1.039，95%CI 1.018 - 1.059；第1年MBDA评分的RR 1.037，95%CI 1.009 - 1.065]。分类后的高MBDA评分也与SvdH进展相关（基线时高MBDA评分的RR为3.7；以低或中度MBDA评分为参照）。在1年时，与低MBDA评分相比，高MBDA评分的RR为4.6。
结论
MBDA评分可预测基线时及疾病过程中的影像学损伤进展。
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